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.

The authors have declared no competing interest.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval for this study was granted by the Institutional Review Board (IRB) of Rajshahi Medical College Hospital (Ref: RMC/IRB/2019/20-011/54, Date: 04 Aug 2020). Detailed information about the study's objectives, procedures, potential risks, and benefits was provided to participants before obtaining informed consent. For illiterate participants, thumbprints were collected in lieu of signatures, witnessed and co-signed. Participants were assured of their right to withdraw from the study at any time without affecting their medical care. The research was conducted in strict adherence to the Helsinki Declaration, ensuring the confidentiality and privacy of all participants. Results from medical examinations were distributed and explained to participants, who were then given the opportunity to discuss their reports with the researcher and receive appropriate guidance as needed.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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Author and Co-authors: 1. Nafisa Naz, MBBS, MS, Email: nafisaa12gmail.com

2. Md Mostafa Monower, MBBS, Mphil, Email: dr.monowergmail.com

3. Shah Md Ahsan Shahid, MBBS, FCPS, MS, FACS, PhD, Email: smashahid293gmail.com

4. Syeda Momena Hossain, MBBS, MS, Email: syedamomenanishigmail.com

5. Tanvir Ahmad, MBBS, MS, Email: tanvirahmad35thgmail.com

6. Baharul Islam, MBBS, FCPS, Email: drbaharulislam64gmail.com

The data supporting the findings of this study are openly available in Zenodo at https://doi.org/10.5281/zenodo.14043746, under the citation: Naz, N. (2024). A Comparative Study of RIPASA and Modified Alvarado Scoring System for the Diagnosis of Acute Appendicitis [Data set]. Access to the dataset requires prior permission from the corresponding author for reuse.