What question did this study set out to answer?

This study aims to compare the diagnostic performance of RIPASA and the Modified Alvarado Score in diagnosing acute appendicitis against histopathological examination.

July 5, 2026BMC Surgery0 citationsOpen Access

Diagnostic performance of RIPASA versus modified Alvarado score in acute appendicitis: a prospective diagnostic accuracy study from a tertiary centre in India

HSHarkirat SinghSawai ManSingh Medical College and Hospital RYRK YadavLala Lajpat Rai Memorial Medical College FKFarukh KhanSawai ManSingh Medical College and Hospital

Key Points

This study aims to compare the diagnostic performance of RIPASA and the Modified Alvarado Score in diagnosing acute appendicitis against histopathological examination.
Prospective study involving 62 patients undergoing appendicectomy for suspected acute appendicitis.
Patients' demographics, symptoms, and laboratory parameters were recorded; RIPASA and MAS scores were assessed pre-operatively.
Outcomes measured included sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve.
HPE confirmed appendicitis in 56 out of 62 (90.3%); RIPASA score showed sensitivity of 94.6% and specificity of 66.7%.
MAS score exhibited sensitivity of 71.4% and specificity of 83.3%.
RIPASA had a significantly higher area under the curve (0.921 vs. 0.821, p = 0.030) and exhibited higher sensitivity compared to MAS (p = 0.0009).

Abstract

Abstract Purpose Acute appendicitis is a common surgical emergency. Clinical scores assist risk stratification where routine advanced imaging is impractical. The Alvarado score’s performance in Asian populations is debated. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was developed for Asian settings. This study prospectively compared RIPASA and the Modified Alvarado Score (MAS) against histopathological examination (HPE) in an Indian tertiary centre. Methods Prospective diagnostic accuracy study of 62 patients undergoing appendicectomy for suspected acute appendicitis at S.M.S. Medical College, Jaipur (January–December 2024). Pre-operative demographics, symptoms, signs and laboratory parameters were recorded; RIPASA (cut-off ≥ 7.5) and MAS (cut-off ≥ 7) were calculated. HPE was the reference standard. Outcomes were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC) with standard error (SE) and 95% confidence interval (CI). AUCs were compared using DeLong’s test, and paired sensitivities and specificities using McNemar’s test. Results Participants were predominantly males (71.0%); mean age 30.66 years. HPE confirmed appendicitis in 56/62 (90.3%); negative appendicectomy rate 9.7%. RIPASA ≥ 7.5: sensitivity 94.6%, specificity 66.7%, PPV 96.4%, NPV 57.1%, AUC 0.921 (SE 0.052; 95% CI 0.820–1.000; p = 0.001). MAS ≥ 7: sensitivity 71.4%, specificity 83.3%, PPV 97.6%, NPV 23.8%, AUC 0.821 (SE 0.083; 95% CI 0.659–0.984; p = 0.010). DeLong’s test showed superior discrimination for RIPASA ( p = 0.030). McNemar’s test demonstrated higher sensitivity for RIPASA ( p = 0.0009), with no significant difference in specificity ( p = 1.000). Conclusion RIPASA demonstrated higher sensitivity and better diagnostic discrimination than MAS in this tertiary surgical cohort, while MAS showed higher specificity. RIPASA may help reduce missed diagnoses in similar high-prevalence emergency settings, although further validation in broader patient populations is warranted.

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