Comparison of the effectiveness of RIPASA and modified Alvarado scores in identifying perforated appendicitis

Acute appendicitis is one of the most common emergency surgical conditions and may progress to perforation, sepsis, and mortality if not treated promptly. This study aimed to evaluate the effectiveness of the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score and the Modified Alvarado Scoring System (MASS) in identifying perforated acute appendicitis.

This study included 164 patients admitted to the General Surgery Department between June 2023 and December 2023 with a preliminary diagnosis of acute appendicitis. MASS and RIPASA scores, along with demographic data, were obtained from the Hospital Information Management System (HIMS) at the time of diagnosis.

A total of 153 patients were included in the final analysis. The mean age was 35.2±14.1 years (range: 18-82 years). Perforation was identified in 15.8% of cases evaluated by ultrasonography (USG) and 6.1% of those assessed by computed tomography (CT). A RIPASA score >7 demonstrated a sensitivity of 71.1% and a specificity of 54.7% for detecting perforation. Patients with perforation had significantly higher RIPASA and MASS scores (both p<0.001) and longer hospital stays (p<0.001).

Compared with the MASS scoring system, the RIPASA score demonstrates higher sensitivity and specificity and is associated with greater inflammation when elevated. Its incorporation into routine clinical practice may facilitate faster, more efficient, and cost-effective management in emergency and general surgical settings.