Diagnosing Appendicitis with Precision: A Comparative Analysis of Modified Alvarado and RIPASA Scoring Systems in a Northern Divisional Hospital of Bangladesh

Abstract

Abstract Objective This study aimed to evaluate the diagnostic efficacy of the Modified Alvarado Scoring System (MASS) and the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system, assessing their sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Methods A cross-sectional analysis was conducted at the Department of General Surgery, Rajshahi Medical College Hospital, Bangladesh, from September to December 2020. The study included 138 purposively selected individuals aged 13 years and above, suspected of acute appendicitis. Data were collected through structured interviews, detailing socio-demographic characteristics, medical history, clinical examinations, and specific laboratory tests (CBC, Urine RE). Histopathology reports from post-operative cases were used as the gold standard for diagnosis. MASS and RIPASA scores, derived from their respective criteria, were analyzed using STATA. Results Participants had a mean age of 26.2 years, with males constituting 55.0% of the sample. The MASS scoring system reported a sensitivity of 79.8%, specificity of 57.9%, PPV of 92.2%, NPV of 31.4%, and an overall diagnostic accuracy of 76.8%. In contrast, the RIPASA scoring system demonstrated a sensitivity of 96.6%, specificity of 73.7%, PPV of 95.8%, NPV of 77.8%, and a diagnostic accuracy of 93.5%. ROC AUC analysis yielded values of 0.6886 for MASS and 0.8516 for RIPASA, indicating a statistically significant difference (p<0.05). Conclusion The findings highlight the superior clinical utility of the RIPASA scoring system over MASS, particularly in settings with limited access to advanced diagnostic facilities. Adopting the RIPASA scoring system could significantly enhance the diagnosis of acute appendicitis, suggesting its potential for improving clinical outcomes in similar healthcare environments.