Diagnosis of Acute Appendicitis in a Tertiary Care Hospital Using Predictive Scoring Systems

Background (Introduction): Acute appendicitis is defined as inflammation of the appendix. Acute appendicitis is one of the most common surgical emergencies, with a prevalence of one in seven in lifetime. It is approximately 1.4 times greater in men than in women. A quick and correct diagnosis of acute appendicitis is based on clinical history, presentation, abdominal examination and laboratory investigations with subsequent early appendectomy can avoid complications arising from perforation. Ultrasonogram is continuity of clinical examination in this condition1. Appendectomy is the most commonly performed emergency operation and can mimic other acute conditions of the abdomen known to cause right iliac fossa pain particularly among the young, the elderly and females of reproductive age. Although appendicitis is a common problem presenting to surgical department, its diagnosis remains difficult and is mainly clinical helped by a few laboratory investigations such as white blood cells. Further aids for making diagnosis are USG and CT of Abdomen and Pelvis which have high sensitivity and specificity but burdens the common man?s pockets and delays the treatment. To overcome this and to reduce the cost burden, many scorings systems are developed based on routine blood investigations we perform to diagnose this condition2. Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA) 6, Alvarado8, Acute Inflammatory Response (AIR) 7 are most commonly used scoring systems in tertiary hospital setup. The aim of this study is to compare the accuracy of all the three scores in diagnosing acute appendicitis by comparing them with the gold standard of histopathologically confirmed appendicitis. Objectives: The objective was to compare the predictive accuracy of the Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA), Alvarado, Acute Inflammatory Response (AIR) scores in patients with right lower quadrant pain for the diagnosis of acute appendicitis. Materials & Methods: a) Design of study-Retrospective descriptive b) Total number of study subjects-100. C) Mode of selection of subjects-All patients treated at the RLJ Hospital for acute appendicitis between January 2019 and December 2020. Patients were identified through a computer-generated search through the Medical Records Department for all patients diagnosed with acute appendicitis. Data were extracted retrospectively from hospital records. All patients were evaluated and graded using Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA), Alvarado, Acute Inflammatory Response (AIR) scores. Conclusion: The RIPASA (Raja IsteriPengiranAnakSaleha Appendicitis) scoring system looked promising when applied to our settings, and had a better sensitivity and specificity than the Alvarado score and AIR (Acute Inflammatory Response) score when applied to Asian populations. A significant reduction in the negative appendicectomy rate was also predicted.