medigraphic.com
ISSN 1561-2945 (Print)

2020, Number 1

<< Back Next >>

Revista Cubana de Cirugía 2020; 59 (1)

RIPASA scale for the diagnosis of acute appendicitis in the Hospital “General Freyre de Andrade”

Martínez RJA, Ramírez GA, Albertini LG, Gómez AK, Rubio GD

Language: Spanish
References: 18
Page: 1-16
PDF size: 464.87 Kb.


ABSTRACT

Introduction: The RIPASA scale was developed for the diagnosis of acute appendicitis and has shown good sensitivity and diagnostic precision, especially in Asian populations.
Objective: To determine the utility of the RIPASA scale for the diagnosis of acute appendicitis.
Methods: Observational, analytical and prospective study with 70 patients admitted and operated on with a presumptive diagnosis of acute appendicitis at the Hospital "General Freyre de Andrade" between September 2015 and December 2017.
Results: 91.4% of the cases presented appendicitis due to histological diagnosis. The most frequent symptom, sign and laboratory data were pain in the right iliac fossa (97.1%), positive rebound (100%), and leukocytosis (87.1%), respectively. The differences between the cases with and without appendicitis for the scale score were statistically significant. Cases with high scores predominated (62.8%). At 7.5 points the sensitivity was 94%, the specificity was 33%, the positive likelihood ratio was 1.41, the negative likelihood ratio was 0.19, and the diagnostic precision was 88.6%. The area under the Receiver Operating Characteristics curve was 0.81.
Conclusions: The RIPASA scale had good sensitivity and a moderate negative likelihood ratio that would allow us to rule out negative cases with low scores. It also exhibited diagnostic accuracy and acceptable overall discriminatory performance. However, the poor specificity and very low positive likelihood ratio make it of little use as a single diagnostic means for acute appendicitis.


REFERENCES

  1. Soler Vaillant R, Mederos Curbelo ON, Galiano Gil JM. Apendicitis aguda. Cap. 52. Cirugía. La Habana: Editorial Ciencias Médicas. 2016 [acceso 22/07/2018]:762-75. Disponible en: http://www.bvscuba.sld.cu/libro/cirugia-tomo-ii-afecciones-quirurgicas-frecuentes/

  2. Richmond B. Apéndice. Sabiston Tratado de Cirugía. 20 Ed. Barcelona, España: Elsevier; 2017. p. 1296-311.

  3. Kularatna M, Lauti M, Haran C, MacFater W, Sheikh L, Huang Y, et al. Clinical Prediction Rules for Appendicitis in Adults: Which Is Best? World J Surg. 1 de julio de 2017;41(7):1769-81. DOI: https://doi.org/10.1007/s00268-017-3926-6

  4. Chong CF, Adi MIW, Thien A, Suyoi A, Mackie AJ, Tin AS, et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 2010 [acceso 02/10/2018];51(3):220-5. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/20428744

  5. Karapolat B. Can RIPASA Scoring System Predict the Pathological Stage of Acute Appendicitis? Emerg Med Int. 2019 [acceso 11/10/2019]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699356/

  6. Singh A, Parihar US, Kumawat G, Samota R, Choudhary R. To Determine Validation of RIPASA Score in Diagnosis of Suspected Acute Appendicitis and Histopathological Correlation with Applicability to Indian Population: a Single Institute Study. Indian J Surg. 2018 [acceso 30/10/2019];80(2):113-7. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/29915475

  7. Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K, et al. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg. 2018;56:307-14. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/30017607

  8. Karami MY, Niakan H, Zadebagheri N, Mardani P, Shayan Z, Deilami I, et al. Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems. Ann Coloproctology. 2017 [acceso 30/10/2019];33(6):227-31. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768477/

  9. Malik MU, Connelly TM, Awan F, Pretorius F, Fiuza-Castineira C, El Faedy O, et al. The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population. Int J Colorectal Dis. 2017 [acceso 30/10/2019];32(4):491-7. Disponible en: https://link.springer.com/content/pdf/10.1007%2Fs00384-016-2713-4.pdf

  10. Arroyo-Rangel C, Limón IO, Vera ÁG, Guardiola PM, Sánchez-Valdivieso EA. Sensibilidad, especificidad y fiabilidad de la escala RIPASA en el diagnóstico de apendicitis aguda en relación con la escala de Alvarado. Cirugía Española. 2018 [acceso 30/10/2019];96(3):149-54. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/29486897

  11. Casado Méndez PR, Santos Fonseca RS, Rosabal Estacio JE, Méndez Jiménez O, Ferrer Magadán CE, Trevín Fernández G, et al. Aplicación de la escala RIPASA en historias clínicas de pacientes egresados con diagnóstico de apendicitis aguda. Rev Cuba Cir. 2017 [acceso 13/11/2019];56(4). Disponible en: http://www.revcirugia.sld.cu/index.php/cir/article/view/609

  12. Díaz-Barrientos CZ, Aquino-González A, Heredia-Montaño M, Navarro-Tovar F, Pineda-Espinosa MA, Espinosa de Santillana IA, et al. Escala RIPASA para el diagnóstico de apendicitis aguda: comparación con la escala de Alvarado modificada. Rev Gastroenterol Mex. 2018 [acceso 30/10/2019];83(2):112-6. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/29426650

  13. Shuaib A, Shuaib A, Fakhra Z, Marafi B, Alsharaf K, Behbehani A, et al. Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis. World J Emerg Med. 2017 [acceso 30/10/2019];8(4):276-80. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675968/

  14. Chae MS, Hong CK, Ha YR, Chae MK, Kim YS, Shin TY, et al. Can clinical scoring systems improve the diagnostic accuracy in patients with suspected adult appendicitis and equivocal preoperative computed tomography findings? Clin Exp Emerg Med. 20 de octubre de 2017 [acceso 27/01/2018];4(4):214-21. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758620/

  15. Erdem H, Çetinkünar S, Daş K, Reyhan E, Değer C, Aziret M, et al. Appendicitis scores for diagnosis of acute appendicitis. World J Gastroenterol. 2013 [acceso 27/01/2018];19(47):9057-62. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870559/pdf/WJG-19-9057.pdf

  16. Nanjundaiah N, Mohammed A, Shanbhag V, Ashfaque K. Comparative Study of RIPASA Score and Alvarado Score in the Diagnosis of Acute Appendicitis. J Clin Diagn Res. 2014 [acceso 30/10/2019];8(11):NC03-5. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290278/

  17. Golden SK, Harringa JB, Pickhardt PJ, Ebinger A, Svenson JE, Zhao Y-Q, et al. Prospective Evaluation of the Ability of Clinical Scoring Systems and Physician-Determined Likelihood of Appendicitis to Obviate the Need for Computed Tomography. Emerg Med J EMJ. 2016 [acceso 30/10/2019];33(7):458-64. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443621/

  18. Davis GN, Swaminathan M. Acute appendicitis - new diagnostic algorithm using RIPASA score and non-contrast Computeed Tomography Scan. JPMA J Pak Med Assoc. 2019 [acceso 30/10/2019];69(Suppl1)(1):S12-6. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/30697011




2020     |     www.medigraphic.com