Publication Date: 2024/02/09
Abstract: Introduction: The incidence of Acute appendicitis, a major cause of acute abdomen, in Africa is low but is said to be progressively increasing. Accurate diagnosis of acute appendicitis, amidst different clinical conditions that mimic it, is challenging and fraught with pitfalls. Clinical scoring systems, developed to aid prompt diagnosis, prevent possible perforations with its challenges and limit negative appendectomies, play a pivotal role in Sub-Saharan Africa where paucity of funds abounds, and novel investigation modalities are lacking. The Alvarado scoring system, the first of such aids, is reported to have varying diagnostic outcomes alongside high perforation rates in sub-Saharan Africa compared to other climes. Better diagnostic tools are still being sought after, and a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), was compared with Alvarado to bridge this gap and solve this challenge at the University of Abuja Teaching Hospital (UATH), Gwagwalada. Objective: To prospectively determine and compare the diagnostic accuracy, specificity, and sensitivity of the RIPASA and Alvarado scoring systems in the diagnosis of acute appendicitis. Patients and Methods: A One-year prospective comparative cross-sectional study in which seventy-nine patients between 7-62 years of age, of both sexes, presenting with pain in the right lower abdominal quadrant and suspected to have acute appendicitis were enrolled. Each patient’s clinical details, alongside their Alvarado and RIPASA scores, were obtained at presentation and a decision for surgery was exclusively based on the clinical findings and the investigations. Only seventy-six patients had surgery based on clinical assessment and these patients were correlated with the histologic diagnoses. Data collated was analyzed using SPSS 25 and the diagnostic accuracy, sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and negative appendectomy rates (NAR) of the scoring systems were determined. Results: The sensitivity, specificity, PPV, NPV and diagnostic accuracy of RIPASA was 97.1%, 71.4%, 97.1%, 71.4% and 94.7% respectively while Alvarado had sensitivity, specificity, PPV, NPV and diagnostic accuracy of 66.7%, 57.1%, 93.9%, 14.8% and 65.8% respectively. The negative appendectomy rate (NAR) based on clinical evaluation was 9.2%. Conclusion: The RIPASA scoring system outperforms the Alvarado scoring system as a diagnostic tool for acute appendicitis. Surgery decisions can be influenced by the RIPASA grading system, and this can help avoid unnecessary procedures.
Keywords: Acute Appendicitis, RIPASA Scores, Alvarado Scores, Diagnostic Accuracy, Negative Appendectomy, Sensitivity, Specificity.
DOI: https://doi.org/10.5281/zenodo.10638498
PDF: https://ijirst.demo4.arinfotech.co/assets/upload/files/IJISRT24FEB041.pdf
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