Chong et al reported the RIPISA score for the diagnosis of acute appendicitis. The authors are from Brunei.
Patient selection: possible acute appendicitis, mean age 26 (+/- 13.5), with range from 0 to > 60 years
Parameters:
(1) sex
(2) age in years
(3) right iliac fossa pain
(4) migration of pain to right lower quadrant (RLQ)
(5) anorexia
(6) nausea and vomiting
(7) duration of symptoms in hours
(8) right iliac fossa tenderness
(9) right iliac fossa guarding
(10) rebound tenderness
(11) Rovsing's sign (indirect tenderness = pressure on the left lower quadrant over a point symmetrical to McBurney's point elicits acute pain at McBurney's point)
(12) fever (not specified)
(13) raised white blood cell count (not specified further)
(14) negative urinalysis (no blood, neutrophils or bacteria in the urine)
(15) foreign National Registration Identify Card (NRIC) in Brunei Darussalam.
|
Parmeters |
Findings |
Points |
|
sex |
male |
1 |
|
|
female |
0.5 |
|
age |
< 40 years |
1 |
|
|
>= 40 years |
0.5 |
|
right iliac fossa pain |
no |
0 |
|
|
yes |
0.5 |
|
migration of pain to RLQ |
no |
0 |
|
|
yes |
0.5 |
|
anorexia |
no |
0 |
|
|
yes |
1 |
|
nausea and vomiting |
no |
0 |
|
|
yes |
1 |
|
duration of symptoms |
< 48 hours |
1 |
|
|
>= 48 hours |
0.5 |
|
right iliac fossa tenderness |
no |
0 |
|
|
yes |
1 |
|
right iliac fossa guarding |
no |
0 |
|
|
yes |
2 |
|
rebound tenderness |
no |
0 |
|
|
yes |
1 |
|
Rovsing's sign |
no |
0 |
|
|
yes |
2 |
|
fever |
no |
0 |
|
|
yes |
1 |
|
raised WBC count |
no |
0 |
|
|
yes |
1 |
|
negative urinalysis |
no |
0 |
|
|
yes |
1 |
|
foreign NRIC |
no |
0 |
|
|
yes |
1 |
total scores =
= SUM(points for all 15 parameters)
Interpretation:
• minimum score: 2
• maximum score: 16
• A cutoff of >= 7.5 was associated with appendicitis.
• The negative appendectomy rate decreased from 16.3% to 6.9%.
Performance:
• The sensitivity is 88% with specificity of 67%.
Specialty: Gastroenterology
