Comparative Evaluation of RIPASA, Alvarado, and Modified Alvarado Scores in Acute Appendicitis Diagnosis

Background: Acute appendicitis is a common surgical emergency characterized by inflammation of the appendix, though diagnosis can be challenging.Scoring systems such as Alvarado are widely used, but their diagnostic accuracy varies regionally.The RIPASA score, developed for Asian populations, claims superior diagnostic performance.This study aimed to validate and compare the RIPASA, Alvarado, and Modified Alvarado scores in an Indian population.Methods: A prospective observational study was conducted from May 2023 to May 2024, involving 100 patients (72 males, 28 females; mean age 30.9 years) presenting with right iliac fossa pain and undergoing appendicectomy at a single center.All patients were evaluated preoperatively using the RIPASA, Alvarado, and Modified Alvarado scores.Histopathological examination (HPE) of the surgical specimen was considered the diagnostic gold standard.Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, negative appendectomy rate, and area under the ROC curve (AUC) were analyzed.Results: Histopathology confirmed appendicitis in 93 patients (negative appendectomy rate: 7%).RIPASA (cutoff 7.5) showed higher sensitivity (96.8%), specificity (62.5%),NPV (71.4%), and accuracy (92.0%) compared to Alvarado (81.7%, 37.5%, 19.0%, 79.0%) and Modified Alvarado (82.8%, 33.3%, 20.0%, 80.0%), respectively (p<0.001).RIPASA also had a lower negative appendectomy rate (3.2%) and greater discriminative ability (AUC 0.83) than Alvarado (0.63) and Modified Alvarado (0.65). Conclusion:The RIPASA score outperformed Alvarado and Modified Alvarado scores in diagnosing acute appendicitis, making it a more reliable diagnostic tool in the Indian population.