Diagnostic Accuracy of Modified Alvarado and RIPASA Scores for Acute Appendicitis in Zakho Emergency Hospital: A Cross-Sectional Study
DOI:
https://doi.org/10.22317/jcms.v12i2.2091Keywords:
Abdominal Pain, Appendicitis, Severity of Illness Index, Clinical Decision Rules, Sensitivity and Specificity, Predictive Value of Tests, Reproducibility of ResultsAbstract
Objective: To compare the diagnostic performance of the Modified Alvarado and RIPASA scoring systems in patients presenting with RIF pain.
Methods: A cross-sectional study was conducted at Zakho Emergency Hospital between October 2022 and May 2023. A total of 195 consecutively admitted patients with RIF pain were evaluated using both scoring systems. Histopathology (when available) served as the reference standard. Statistical analysis included descriptive statistics, two-tailed independent t-tests, ANOVA, chi-square tests, logistic regression, and receiver operating characteristic (ROC) curve analysis. Sensitivity, specificity, predictive values, accuracy, and area under the curve (AUC) were calculated with 95% confidence intervals (CI).
Results: Histopathology confirmed appendicitis in 141 patients (72.3%). Using a cutoff ≥7, the MA score showed sensitivity 67.4%, specificity 61.1%, PPV 83.3%, NPV 41.8%, and accuracy 65.6%. The RIPASA score (cutoff ≥10) demonstrated sensitivity 75.9%, PPV 86.3%, NPV 45.8% and accuracy 72.3%, with identical specificity (61.1%). Logistic regression confirmed both scores as significant predictors (p < 0.001). ROC analysis demonstrated acceptable discrimination for both systems.
Conclusion: Both scoring systems demonstrated moderate diagnostic performance. RIPASA showed higher sensitivity and overall discrimination; however, the difference was not statistically significant. These findings suggest that RIPASA may provide incremental diagnostic benefit, but neither score should replace imaging in equivocal cases.
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