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June 5, 2026Open Access

Diagnostic Accuracy of the Modified Alvarado and RIPASA Scoring Systems in Acute Appendicitis: A Retrospective Cohort Study

AVArturo VergaraFundación Santa Fe de Bogotá FGFelipe GirónUniversidad de Los Andes RNRicardo E. NuñezUniversidad de Los Andes

Key Points

To assess the diagnostic accuracy of the modified Alvarado and RIPASA scores against histopathological findings in adults undergoing laparoscopic appendectomy.
Conducted a retrospective cohort study of 501 adult patients who underwent laparoscopic appendectomy for suspected appendicitis.
Calculated modified Alvarado and RIPASA scores and assessed their association with histopathological severity.
Statistical significance was evaluated at a two-sided p < 0.05.
490 patients (97.8%) had histopathologically confirmed appendicitis; 38.5% had complicated appendicitis.
Both scores showed high sensitivity (>97%) but low specificity (<4%).
The Alvarado score was associated with intraoperative severity (OR 1.25, 95% CI 1.12–1.40; p < 0.001), and RIPASA score (OR 1.12, 95% CI 1.03–1.21; p = 0.008).

Abstract

ABSTRACT Background : Acute appendicitis (AA) is the leading cause of acute abdomen requiring emergency surgery worldwide. Clinical scoring systems such as the modified Alvarado and RIPASA scores are widely used to improve diagnostic accuracy. Evidence comparing these measurement scales against histopathological findings in our population remains limited, highlighting the need for local validation studies. Objective : To evaluate the diagnostic performance of the Alvarado and RIPASA scores against histopathological findings in adult patients undergoing laparoscopic appendectomy at a quaternary referral center. Methods : A retrospective cohort study was conducted including consecutive patients ≥18 years who underwent laparoscopic appendectomy for suspected AA between January 2021 and June 2022. Alvarado and RIPASA scores were calculated. Associations between scores and histopathological severity were assessed. Statistical significance was set at a two-sided p 97%); however, specificity was markedly low (<4%), and overall AUC values were close to chance (Alvarado: 0.566; RIPASA: 0.496), reflecting severe spectrum bias due to the surgical selection of this cohort. Nonetheless, both the Alvarado (OR 1.25, 95% CI 1.12–1.40; p < 0.001) and RIPASA (OR 1.12, 95% CI 1.03–1.21; p = 0.008) scores were statistically associated with intraoperative disease severity. Similarly, an NLR exceeding 9.95 was associated with complicated appendicitis (p < 0.01). These odds ratios reflect epidemiological associations and should not be interpreted as measures of predictive or diagnostic performance Conclusion : In this surgically managed cohort, both scoring systems demonstrated high sensitivity but modest overall discriminatory metrics, a pattern primarily attributed to spectrum bias. Nevertheless, their statistically significant association with intraoperative severity and the observed association with NLR suggest potential descriptive value in characterizing disease complexity within this surgically selected population. These findings should not be interpreted as evidence of clinical predictive capacity or standalone diagnostic utility.

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