Diagnostic Accuracy and Educational Value of the RIPASA Score in Suspected Acute Appendicitis: A Prospective Study in
Khedija Zaouche1, Sourour Chamekh2, Rahma Yousfi3
1Emergency Department, Mahmoud El Matri Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Background:
Clinical scoring systems are increasingly used in emergency departments for decision support and risk stratification. This prospective observational study evaluated the diagnostic performance of the RIPASA score in suspected acute appendicitis and explored its potential role as a structured decision-support tool within a training environment.
Methods:
We conducted a prospective observational study in a university emergency department including patients aged ≥18 years presenting with suspected acute appendicitis. The RIPASA score was calculated during routine clinical assessment by physicians with varying levels of experience. Histopathological findings served as the reference standard for operated patients, while non-operated patients were followed for one month. Diagnostic performance was assessed using receiver operating characteristic analysis.
Results:
Among 135 included patients (median age 28 years), acute appendicitis was confirmed in 55 cases (40.7%). The RIPASA score demonstrated moderate diagnostic accuracy, with an area under the curve of 0.79 (95% CI, 0.72-0.87). The negative predictive value in the low-probability group reached 86.4%, whereas the positive predictive value in the high-probability group was 67.4%.
Conclusion:
The RIPASA score demonstrated moderate diagnostic performance for risk stratification in suspected acute appendicitis. While it may support structured clinical reasoning in training settings, it should not be used as a standalone tool for discharge decisions.
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