• Ismail Akbar Ayub Medical College Abbottabad
  • Jawad Ahmed Shehzad Surgery ATH
  • Shoaib Ali Surgery, ATH


Background: Acute appendicitis is one of the most common acute surgical emergencies on emergency room floor and timely diagnosis of the condition is of utmost importance. Multiple diagnostic Score exist to help in the clinical diagnosis; among Which RIPASA is a recent introduction. Methods: The study was carried out Ayub Teaching hospital of Abbottabad from Sept-2017 to Feb-2018, Department of General Surgery. The ultimate decision to perform surgery was not guided by the scores and the surgeon’s decision was the final word, and specimens were sent afterward for histopathology. The results compiled and entered into SPSS 20. Results: Out of the 308, 288 patients underwent surgery for AP, 165 (57.3%) were male and 123 (42.7%) were female, 252 (87.5%) had positive histopathology report and 36 (12.5%) had a negative report, with resultant negative appendectomy rate of 12.5% well below the average. 26 (9.02%) had a perforated appendix and 8 (2.8%) had post-op wound infection. The sensitivity of RIPASA score at a cut-off value of 7.5 was 98.02%, with specificity of 75%, and Positive Predictive Value of 96.48%, and Negative Predictive Value of 84.7%. Compared to Alvarado’s Score Sensitivity and Specificity of 53% and 75% respectively. Conclusion: On the balance the RIPASA Score detects early preventing from dreadful complication and in turn have low specificity giving way to a slightly higher negative appendectomy rate with the consequent morbidity and mortality of unnecessary surgery. Still RIPASA Score outperforms the Alvarado and Modified Alvarado Score.Keywords: Acute Appendicitis; RIPASA Score; South-Asian Population

Author Biographies

Ismail Akbar, Ayub Medical College Abbottabad

Assistant professor

Jawad Ahmed Shehzad, Surgery ATH


Shoaib Ali, Surgery, ATH

Surgery, ATH


Schleef J, Puri P. Appendicitis. In: Puri P, Höllwarth M, editors. Pediatric surgery: diagnosis and management. 1st ed. Berlin: Springer, 2009; p.477–84.

Sulu B. Demographic and Epidemiologic Features of Acute Appendicitis. Append Collect Essays World Rij InTech 2012;169–78.

Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med 2012;5:789–97.

Kendall JL, Moreira ME. Evaluation of the adult with abdominal pain in the emergency department. [Internet]. UpToDate 2017 [cited 2018 Sep 13]. Available from: https://www.uptodate.com/contents/evaluation-of-the-adult-with-abdominal-pain-in-the-emergency-department

Stahlfeld K, Hower J, Homitsky S, Madden J. Is acute appendicitis a surgical emergency? Am Surg 2007;73(6):629–30.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15(5):557–64.

Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Engl 1994;76(6):418–9.

Chong CF, Adi MI, Thien A, Suyoi A, Mackie AJ, Tin AS, et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J 2010;51(3):220–5.

Kim SH, Park SJ, Park YY, Choi SII. Delayed appendectomy is safe in patients with acute nonperforated appendicitis. Int Surg 2015;100(6):1004–10.

Nanjundaish N, Mohammed A, Shanbhag V, Ashfaque K, Priya SA. Acomparative study of RIPASA Score and ALVARADO Score in the diagnosis of Acute Appendicitis. J Clin Diagn Res 2014;8(11):NC3–5.

Mohan D, Barnato AE, Rosengart MR, Farris C, Yealy DM, Switzer GE, et al. Trauma triage in the emergency departments of nontrauma centers: an analysis of individual physician caseload on triage patterns. J Trauma Acute Care Surg 2013;74(6):1541–7.

Seetahal SA, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Fredrick W, et al. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg 2011;201(4):433–7.

Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging 2016;7(2):255–63.

Pinto F, Pinto A, Russo A, Cuppolino F, Bracale R, Fonio P, et al. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Crit Ultrasound J 2013;5(Suppl 1):S2.

Chiang DT, Tan EI, Bricks D. ‘To have…or not to have’. Should computed tomography and ultrasonography be implemented as routine work-up for patients with suspected acute appendicitis in a regional hospital? Ann R Coll Surg Engl 2008;90(1):17–21.

Nirajlal B, Gabriel R, Anand R, Sohil AK. Evaluation of Alvarado Score in Acute Appendicitis: A Prospective Study. Internet J Surg 2011;9(1):1–5.

Khan I, Ur Rehman A. Application of Alvarado scoring system in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2005;17(3):41–4.

Al-Hashemy AM, Seleem MI. Appraisal of the modified Alvarado Score for acute appendicitis in adults. Saudi Med J 2004;25(9):1229–31.

Abou Mehri B, Khalil M, Daoud N. Comparison of Alvarado score evaluation and clinical judgement in acute appendicitis. Med Arch 2014;68(1):10–3.

Butt MQ, Chatha SS, Ghumman AQ, Farooq M. RIPASA score: a new diagnostic score for diagnosis of acute appendicitis. J Coll Physicians Surg Pak 2014;24(12):894–7.

Peltokallio P, Tykka H. Evalution of the age distribution and mortality of acute appendicitis. Arch Surg 1981;116(2):153–6.

Poortman P, Oostvogel H, Lohle P, Cuesta MA, de Lange-de Klerk E, Hamming JF. Ultrasonography and clinical observation in women with suspected acute Appendicitis: A prospective cohort study. Dig Surg 2009;26(2):163–8.

Whitworth CM, Whitworth PW, Sanfillipo J, Polk HC Jr. Value of diagnostic laparoscopy in young women with possible appendicitis. Surg Gynecol Obstet 1988;167(3):187–90.

Tsai SH, Hsu CW, Chen SC, Lin YY, Chu SJ. Complicated acute appendicitis in diabetic patients. Am J Surg 2008;196(1):34–9.

Panagoulis G, Tentolouris N, Ladas SS. Abdominal pain in an adult with Typue 2 diabetes: A case report. Cases J 2008;1(1)154.

Koduri S, Gupta SH. Abdominal pain and vomiting in an elderly diabetic woman. Postgrad Med J 2003;79(938):709.



Most read articles by the same author(s)