Accuracy of the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado Score for Acute Appendicitis: A...

Acute appendicitis is the most frequent surgical emergency worldwide, but due to atypical symptoms, its diagnosis is challenging. The Alverado score is widely used but is limited in Asian populations, prompting the development of the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score. This study aims to compare the accuracy of both systems.

A prospective study was conducted at Hayatabad Medical Complex, Peshawar, from August 2024 to September 2025, including 100 patients with suspected acute appendicitis. Both RIPASA and Alvarado scores were assessed and compared with intraoperative findings using the Gomez classification. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated.

The mean patient age was 28.1 years; 54% were male. Common presenting features were anorexia (90%), tenderness (99%), rebound tenderness (94%), and pain migration (76%). The RIPASA score showed sensitivity of 91.9%, specificity of 64.3%, PPV of 94.1%, NPV of 56.3%, and accuracy 88%. The Alvarado score demonstrated sensitivity of 94.2%, specificity of 57.1%, PPV of 93.1%, NPV of 61.5%, and accuracy 89%. Receiver operating characteristic (ROC) analysis yielded an area under the curve (AUC) of 0.78 for RIPASA and 0.76 for Alvarado.

Both the RIPASA and Alvarado scores demonstrated high accuracy, with Alvarado showing slightly higher sensitivity (94.2% vs. 91.9%) and RIPASA offering better specificity (64.3% vs. 57.1%). Overall, both scoring systems proved reliable tools for diagnosis, helping reduce negative appendectomy rates and improving clinical decision-making.