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Original Articles
- Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems
- Mohammad Yasin Karami, Hadi Niakan, Navid Zadebagheri, Parviz Mardani, Zahra Shayan, Iman Deilami
- Ann Coloproctol. 2017;33(6):227-231. Published online December 31, 2017
- DOI: https://doi.org/10.3393/ac.2017.33.6.227
- 8,813 View
- 133 Download
- 27 Web of Science
- 25 Citations
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Abstract
PDF Purpose Acute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population.
Methods We prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined.
Results The sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores.
Conclusion The RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.
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Citations
Citations to this article as recorded by
- Clinical scores for acute appendicitis in adults: A systematic review and meta-analysis of diagnostic accuracy studies
Luis Adrian Alvarez-Lozada, Bernardo Alfonso Fernandez-Reyes, Francisco Javier Arrambide-Garza, Mariana García-Leal, Neri Alejandro Alvarez-Villalobos, Javier Humberto Martínez-Garza, Bernardo Fernández-Rodarte, Rodrigo E. Elizondo-Omaña, Alejandro Quirog
The American Journal of Surgery.2025; 240: 116123. CrossRef - 31/w mit Mittelbauchschmerzen und einmaligem Erbrechen
Dorothea Sauer
Notfall + Rettungsmedizin.2025; 28(S2): 107. CrossRef - How successful are Alvarado and air scores in excluding gynecopathologies?
Goksever Akpinar, Batuhan Eyduran, Alaattin Karabulut, Baris Eker
Journal of Obstetrics and Gynaecology Research.2025;[Epub] CrossRef - Evaluating the Diagnostic Accuracy of the Alvarado Score and Abdominal Ultrasound for Acute Appendicitis: A Retrospective Single-Center Study
Saleh Al-wageeh, Qasem Alyhari, Faisal Ahmed, Abdulfattah Altam, Gubran Alshehari, Mohamed Badheeb
Open Access Emergency Medicine.2024; Volume 16: 159. CrossRef - EVALUATION OF ALVARADO SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS
Sumia Dra
Libyan Journal of Medical Research.2024; 18(1): 172. CrossRef - Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score in predicting acute appendicitis
Muhammad Zeb, Sabir Khan Khattak, Maryam Samad, Syed Shayan Shah, Syed Qasim Ali Shah, Abdul Haseeb
Heliyon.2023; 9(1): e13013. CrossRef - A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis
Sapna Gupta, Venkata S. Kolli, Kimberly Da Costa, Sariya Javed, Ahmed Ammar, Ashraf Rasheed
Annals of Medicine & Surgery.2023; 85(2): 111. CrossRef - Modificación de la efectividad diagnóstica de la escala RIPASA en pacientes con apendicitis aguda y consumo de analgésicos no esteroideos
Pedro Josué Araujo Ramírez, Ricardo Sanabria Trujillo, Sergio Hernández Aguilar, Francisco Javier Hernández Hernández
Acta Médica Grupo Ángeles.2023; 21(2): 123. CrossRef - Performance and diagnostic accuracy of scoring systems in adult patients with suspected appendicitis
David Eng Yeow Gan, Nik Ritza Kosai Nik Mahmood, Jitt Aun Chuah, Firdaus Hayati
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef - Comparison of RIPASA and ALVARADO scores for risk assessment of acute appendicitis: A systematic review and meta-analysis
Giuliana Favara, Andrea Maugeri, Martina Barchitta, Andrea Ventura, Guido Basile, Antonella Agodi, Ibrahim Umar Garzali
PLOS ONE.2022; 17(9): e0275427. CrossRef - Diagnostic Accuracy Rates of Appendicitis Scoring Systems for the Stratified Age Groups
Emre Gonullu, Zulfu Bayhan, Recayi Capoglu, Barış Mantoglu, Burak Kamburoglu, Tarık Harmantepe, Fatih Altıntoprak, Unal Erkorkmaz, Roberto Cirocchi
Emergency Medicine International.2022; 2022: 1. CrossRef - Serum Bilirubin as a Predictor of Complications of Acute Appendicitis in Adults
K P C Muhammed Irfan, C Rajeev, A Mohamad Safwan, Shafy Ali Khan, K N Vijayan, Liju Varghese
Kerala Surgical Journal.2022; 28(2): 182. CrossRef - Consensus Statement of the Italian Polispecialistic Society of Young Surgeons (SPIGC): Diagnosis and Treatment of Acute Appendicitis
Eleonora Guaitoli, Gaetano Gallo, Eleonora Cardone, Luigi Conti, Simone Famularo, Giampaolo Formisano, Federica Galli, Giuseppe Giuliani, Antonio Martino, Alessandro Pasculli, Romeo Patini, Domenico Soriero, Vincenzo Pappalardo, Gianmaria Casoni Pattacini
Journal of Investigative Surgery.2021; 34(10): 1089. CrossRef - Validation of the Appendicitis Inflammatory Response (AIR) Score
Manne Andersson, Blanka Kolodziej, Roland E. Andersson
World Journal of Surgery.2021; 45(7): 2081. CrossRef - Acute inflammatory response and Alvarado scoring systems in the diagnosis of acute appendicitis: which one is more accurate?
Abdoulhossein Davoodabadi, Hassan Zandi, Alireza Moravveji, Mohammad J. Azadchehr
Chirurgia.2021;[Epub] CrossRef - Diagnostic accuracy of Alvarado, RIPASA and Tzanakis scoring system in acute appendicitis: A prospective observational study
Pushkar Sharma, Ankit Jain, Gomathi Shankar, Sreerekha Jinkala, Uday S Kumbhar, Sreenath G Shamanna
Tropical Doctor.2021; 51(4): 475. CrossRef - Acute appendicitis–advances and controversies
Thomas Zheng Jie Teng, Xuan Rong Thong, Kai Yuan Lau, Sunder Balasubramaniam, Vishal G Shelat
World Journal of Gastrointestinal Surgery.2021; 13(11): 1293. CrossRef - RIPASA versus Alvarado score in the assessment of suspected appendicitis in children: a prospective study
Tülin Öztaş, Muhammet Asena
Annals of Pediatric Surgery.2021;[Epub] CrossRef - Predictive value of scoring systems for the diagnosis of acute appendicitis in emergency department patients: Is there an accurate one?
Rohat Ak, Fatih Doğanay, Ebru Unal Akoğlu, Haldun Akoğlu, Aslı Bahar Uçar, Erdem Kurt, Cansu Arslan Turan, Ozge Onur
Hong Kong Journal of Emergency Medicine.2020; 27(5): 262. CrossRef - Comparison of Raja Isteri Pengiran Anak Saleha Appendicitis and modified Alvarado scoring systems in the diagnosis of acute appendicitis
Nurullah Damburacı, Barış Sevinç, Murat Güner, Ömer Karahan
ANZ Journal of Surgery.2020; 90(4): 521. CrossRef - Empfehlungen zur Therapie der akuten Appendizitis
M. Andric, J. C. Kalff, W. Schwenk, S. Farkas, W. Hartwig, A. Türler, R. Croner
Der Chirurg.2020; 91(9): 700. CrossRef - COMPARİSON OF ALVARADO AND RIPASA SCORES İN PATİENTS WİTH ACUTE APPENDİCİTİS
Mine ESMER GÖKÇE, İ̇lhan KORKMAZ, Yusuf TEKİN, Sefa YURTBAY, Erdal DEMİRTAŞ, Orhan ÖZSOY, Sedat ÖZBAY, Fatma KUKUL GÜVEN
Cumhuriyet Medical Journal.2020;[Epub] CrossRef - Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis
Senol Tahir, Andrej Nikolovski, Martina Ambardjieva, Petar Markov, Dragoslav Mladenovik, Gjulsen Selim, Beti Zafirova-Ivanovska, Vlado Janevski
Lietuvos chirurgija.2020; 19(3-4): 109. CrossRef - Scoring Systems in Acute Appendicitis - A Review
Aditya Vijay Mundada, Yeshwant Lamture, Meenakshi Yeola
Journal of Evolution of Medical and Dental Sciences.2020; 9(51): 3881. CrossRef - Can RIPASA Scoring System Predict the Pathological Stage of Acute Appendicitis?
Banu Karapolat
Emergency Medicine International.2019; 2019: 1. CrossRef
- Clinical scores for acute appendicitis in adults: A systematic review and meta-analysis of diagnostic accuracy studies
- The Efficacy of the Alvarado Score in the Diagnosis of Acute Appendicitis.
- Lee, Sung Min , Chang, In Taik , Kim, Beom Gyu , Cha, Sung Jae , Kim, Yong Seok , Pak, Jun Seok
- J Korean Soc Coloproctol. 2008;24(1):1-6.
- DOI: https://doi.org/10.3393/jksc.2008.24.1.1
- 2,928 View
- 24 Download
- 2 Citations
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Abstract
PDF
- PURPOSE
Acute appendicitis is the most common cause of an acute abdomen that needs an emergency operation. However, the preoperative diagnosis is difficult. The purpose of this study is to assess the diagnostic efficacy of the Alvarado score by a comparison with CT and to determine the indication of CT evaluation. METHODS: From August 2006 to October 2006, 111 consecutive patients were admitted to Chung-Ang University hospital under the impression of acute appendicitis, and a CT scan was done. The Alvarado score, which consists of migration, anorexia, nausea-vomitig, tenderness, rebound tenderness, fever, leukocytosis, and left shift, was applied to the patients. RESULTS: Of the 111 patients, 85 patients underwent an operation, and 26 were discharged without an operation on the basis of the CT finding. The negative appendectomy rate were 4.7%. CT showed a sensitivity, of 0.90 a specificity of 0.97 and an accuracy rate of 0.92. Tenderness and leukocytosis were confirmed as the most important tests and showed accuracy rates of 0.73 and 0.70, respectively. The sensitivity was 0.90 at score 5 and 0.85 at score 7. Therefore, there was no single cut-off score that satisfied all diagnostic values. CONCLUSIONS: The Alvarado score alone is not a satisfactory diagnostic method acute appendicitis. Of the appendicitis patients, 90% might be included in the diagnosis for Alvarado scores above 5, and the negative appendectomy could be as high as 15% for Alvarado scores above 7, which is the score generally accepted for a diagnosis of appendicitis. -
Citations
Citations to this article as recorded by
- Application of the Alvarado Score to the Diagnosis of Acute Appendicitis.
- Kim, Hea Eun , Park, Sung Bae , Woo, Sang Uk , Rho, Hye Rin , Chae, Gi Bong , Choi, Won Jin
- J Korean Soc Coloproctol. 2006;22(4):229-234.
- 1,494 View
- 27 Download
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Abstract
PDF
- PURPOSE
The purpose of this study is to confirm the clinical usefulness of the Alvarado score's application and the differences in diagnostic values between male and female for patients who were diagnosed with acute appendicitis when they came to the hospital for pain in the right lower abdomen.
METHODS
The subjects of this study were 211 patients who entered the surgical department of this hospital for doubtful acute appendicitis from June 2003 to May 2005. Using a retrospective method, we examined the patients' records and compared their ages, sex, symptoms, preoperative physical examinations, leukocyte and neutrophils figures, and the final postoperative pathological diagnosis.
RESULTS
One hundred twelve patients were male, and 99 were female. A clinical Alvarado score of above 7 in sensitivity, specificity, positive predictive value, and negative predictive value was the standard for being judged positive. In this study, the sensitivity of the Alvarado score was 86.2%, its specificity was 61.6%, and the accuracy of diagnosis was 82.9%. The positive predictive value was 92.6%, and the negative predictive value was 51.0%. The accuracies were 83.9% and 81.8%, respectively, that for males being a little higher than that for female, but with no statistically significant differences.
CONCLUSIONS
This study showed that the diagnosis of acute appendicitis was highly accurate for an Alvarado score above 7 (82.9%). The diagnosis of acute appendicitis by using the Alvarado score is simple, fast, reliable, and repeatable, and it can be used under any conditions without other expensive and complicated diagnostic tools.
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