RIPASA Score for Acute Appendicitis

Why Use

Negative appendectomies were relatively common in the RIPASA study cohorts, suggesting that use of the score might have reduced unnecessary surgeries while missing few with appendicitis.

When to Use

Patients being evaluated for acute appendicitis.

Formula

Pearls / Pitfalls

RIPASA is a scoring system for diagnosing appendicitis. Similar to the Alvarado Score , it typically provides a quantitive value for a clinician's clinical gestalt of appendicitis. It is very accurate for the diagnosis of appendicitis when above a point threshold - typically above 7.5 points. Points to keep in mind: It has been most widely studied in Asian populations (Singapore, India) and less so in Western populations. Because it was developed in Singapore which has a large number of foreign nationals, the “Foreign national registration identity card” was included in the score as it was found to have some predictive capacity. This is harder to apply to other populations.

Management

We are unaware of validated management algorithms using the RIPASA Score.

Critical Actions

The RIPASA Score integrates and thus requires a number of laboratory test results and historical features, and while accuracy is high in initial studies, a larger more rigorous validation and/or implementation study would be very useful.

Advice

In settings where advanced imaging is used more liberally, the performance of the RIPASA Score is unclear, and no study has yet assessed its impact when applied clinically.

More Information

The cutoff value of 7.5 points was 98% sensitive and 81% specific for diagnosis of appendicitis.