Methods used to improve the accuracy of diagnosis of acute appendicitis are reviewed. Laparoscopy, barium enema, ultrasonography and computer assistance have all been shown to improve accuracy, but no one method is of proven superiority. Such diagnostic aids or intensive in-hospital observation must be used to reduce the 15-30 per cent negative laparotomy rate when acute appendicitis is suspected, without increasing the incidence of appendiceal perforation.

Aids in the diagnosis of acute appendicitis

Introduction Acute appendicitis is one of the most common surgical emergencies. The Alvarado and modified Alvarado scores have been developed to aid diagnosis, but both scoring systems have poor sensitivity and specificity when applied in Middle Eastern and Asian populations. The aim of this study was to develop a new scoring system that is suitable for the local population. Methods Clinical data from 312 patients who had undergone an emergency appendicectomy was retrospectively collected and used to generate 15 parameters. The probability was calculated and a score of 0.5, 1.0 or 2.0 was allocated to each parameter. The receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the new scoring system were derived using the StatsDirect statistical software. Results The 15 parameters and the scores generated were age (less than 40 years is 1 point; greater than 40 years is 0.5 point), gender (male is 1 point; female is 0.5 point), right iliac fossa (RIF) pain (0.5 point), migration of pain to RIF (0.5 point), nausea and vomiting (1 point), anorexia (1 point), duration of symptoms (less than 48 hours is 1 point; more than 48 hours is 0.5 point), RIF tenderness (1 point), guarding (2 points), rebound tenderness (1 point), Rovsing's sign (2 points), fever (1 point), raised white cell count (1 point), negative urinalysis (1 point) and foreign national registration identity card (1 point). The optimal cut-off threshold score from the ROC was 7.5, with a sensitivity of 88 percent, a specificity of 67 percent, a PPV of 93 percent and an NPV of 53 percent. The negative appendicectomy rate decreased significantly from 16.3 percent to 6.9 percent, which was a 9.4 percent reduction (p is 0.0007). Conclusion The new appendicitis scoring system looked promising when applied to our settings, and had a better sensitivity and specificity than the Alvarado score when applied to Asian populations. A significant reduction in the negative appendicectomy rate was also predicted. A prospective evaluation of this new appendicitis scoring system, referred to as the RIPASA score, is ongoing.

Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis.

Appendicitis is a condition characterized by inflammation of the appendix. All cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of peritonitis and shock.[1] Reginald Fitz first described acute and chronic appendicitis in 1886,[2] and it has been recognized as one of the most common causes of severe acute abdominal pain worldwide.

Appendicitis

Introduction: Acute appendicitis is one of the most common surgical emergencies. The Alvarado and modified Alvarado scores have been developed to aid diagnosis, but both scoring systems have poor sensitivity and specificity when applied in Middle Eastern and Asian populations. The aim of this study was to develop a new scoring system that is suitable for the local population. Methods: Clinical data from 312 patients who had undergone an emergency appendicectomy was retrospectively collected and used to generate 15 parameters. The probability was calculated and a score of 0.5, 1.0 or 2.0 was allocated to each parameter. The receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the new scoring system were derived using the

/pdf/development-of-the-ripasa-score-a-new-appendicitis-scoring-yz72ciecso.pdf

Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis Chong C F, Adi M I W, Thien A, Suyoi A, Mackie A J, Tin A S, Tripathi S, Jaman N H, Tan K K, Kok K Y, Mathew V V, Paw O, Chua H B, Yapp S K

Laparoscopy has been performed in 32 patients in whom the diagnosis of appendicitis was suspected, but in whom clinical findings were equivocal and insufficient to establish the diagnosis. These patients represented 13.6% of the total group of patients admitted with questionable appendicitis during this period. Fifty per cent of these 32 patients had unusual clinical features, such as a prolonged history of symptoms, significant intercurrent disease, prior treatment with antibiotics or steroids, etc. At laparoscopy, the diagnosis of acute appendicitis was made in 17 patients. Another disease was diagnosed in 8 patients, and 7 were judged to have no pathologic abnormalities. There were two false negative examinations and one false positive, but no ruptured appendices resulted. Twelve patients (37.5%) were spared operation by laparoscopy. The negative appendectomy rate was decreased from 10 to 1%.

Laparoscopy for questionable appendicitis: can it reduce the negative appendectomy rate?

Appendicitis and mimicking conditions. A prospective study.

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Appendicitis and mimicking conditions. A prospective study.