ArticleCureus2025
Diagnostic Accuracy of Alvarado Versus Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Scores With Histopathology As Gold Standard for Acute Appendicitis: A Cross-Sectional Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Preoperative differentiation of acute appendicitis using NLR, SII, and maximum appendiceal diameter: a retrospective single-center diagnostic study.Frontiers in surgery · 2026Article
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7 authors.
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Abstract
backgroundDiagnosing acute appendicitis is challenging in developing countries. The Alvarado and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring systems have varying accuracies in diagnosing this condition. This study compares their diagnostic accuracy in our population.
objectiveTo assess the diagnostic accuracy of Alvarado and RIPASA score for preoperatively diagnosing acute appendicitis, using histopathology as the gold standard.
methodsA cross-sectional study was conducted from April 2021 to April 2022 at the Department of Surgery, Dr. Ruth K. M. Pfau Civil Hospital, Karachi. The estimated sample size was 187. The demographic and clinical characteristics of the patients were presented using frequency and percentage. Moreover, the chi-square test was applied to analyze the comparison between Alvarado and RIPASA scores for acute appendicitis. Sensitivity, specificity, and diagnostic accuracy were computed for both scoring systems. Histopathology reports served as the reference standard for diagnosis. The area under the Receiver Operating Curve (ROC) was determined for both Alvarado and RIPASA scores. A significance level of P value <0.05 was deemed statistically significant.
resultsOut of 187 participants, 82% (n=153) were diagnosed with appendicitis, comprising 125 male subjects and 62 female subjects. The mean age was recorded as 26.4 ± 8.5 years. The Alvarado score demonstrated sensitivity, specificity, and diagnostic accuracy of 93%, 31%, and 70%, respectively, while the RIPASA score showed sensitivity, specificity, and diagnostic accuracy of 83%, 36.3%, and 63%, respectively. The area under the ROC curve was 0.70 for the Alvarado score and 0.63 for the RIPASA scoring system.
conclusionIn our study, the Alvarado score proved to be a more precise and sensitive diagnostic tool for identifying acute appendicitis in comparison to the RIPASA score. Due to its simplicity and reliable performance, the Alvarado score may be more practical to use where access to advanced diagnostic tools is restricted in resource-limited environments.
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