BACKGROUND Acute appendicitis is very commonly diagnosed when a patient presents with acute abdomen. This is more commonly seen in the young and middle-aged individuals. The clinical signs and symptoms determine the diagnosis and management. Scoring systems are in plenty to diagnose acute appendicitis and mainly include the presenting signs and symptoms, but are not acceptable for all populations with different age groups. Modified Alvarado scoring system is a timed tested scoring system used in different populations and age groups with good efficacy and to provide a bedside clinical diagnosis of acute appendicitis. The purpose of this study was to assess effectiveness of modified Alvarado score in the early diagnosis of acute appendicitis. METHODS A prospective observational study was done which incorporated 50 patients presenting with the signs and symptoms pointing out to acute appendicitis, clinically. The patients were evaluated by Modified Alvarado score during admission and based on the treating surgeon’s decision, were operated. Finally, the score was compared with the diagnosis achieved with a histopathological examination of the operated specimen. RESULTS The sensitivity of raja isteri penigran anak saleha appendicitis (RIPASA) score was 70.58 %, specificity was 68.75 %, positive predictive value (PPV) was 82.75 %, negative predictive value (NPV) of RIPASA score was 52.38 % and the diagnostic accuracy of RIPASA score was 70 %. CONCLUSIONS Modified Alvarado scoring system is simple scoring system which can be used in a bedside manner but uses specific and limited features for the diagnosis of acute appendicitis which limits the effectiveness of this scoring system. KEY WORDS Acute Abdomen, Clinical Scoring System, Modified Alvarado Scoring System

IntroductionAcute appendicitis is the commonest abdominal surgical emergency globally. The most accepted management of acute appendicitis is surgical, either open or laparoscopic appendectomy. Overlapping clinical presentations with many genitourinary and gynecological conditions lead to difficulty in accurate diagnosis, making negative appendectomies an unwanted reality. With the advancement in technology, there have been constant efforts to minimize negative appendectomy rates (NAR) using imaging modalities like USG of the abdomen and the gold-standard imaging test, the contrast-enhanced computed tomography of the abdomen. Due to the cost incurred and the lesser availability of such imaging modalities and needed expertise in resource-poor settings, various clinical scoring systems were devised to accurately diagnose acute appendicitis and thereby decrease NAR. We conducted our study to determine the NAR between the Raja Isteri Pengiran Anak Saleha Appendicitis score (RIPASA) and the modified Alvarado (MA) scoring methods. MethodsA prospective observational analytical study was conducted, including 50 patients presenting to our hospital with acute appendicitis and who underwent emergency open appendectomy. The need to operate was decided by the treating surgeon. Patients were stratified by both scores; the pre-operative scores were noted and were later compared with the histopathological diagnosis. ResultsA total of 50 clinically diagnosed patients with acute appendicitis were evaluated utilizing the RIPASA and the MA scores. The NAR was 2% using the RIPASA score vs 10% with the MA score. The sensitivity was 94.11% vs 70.58% (p<0.0001), the specificity was 93.75% vs 68.75% (p<0.0001), the positive predictive value (PPV) of 96.96% vs 82.75% (p<0.001), the negative predictive value (NPV) of 88.23% vs 52.38% (p<0.001), and NAR of 2% vs 10% (p<0.0001) in the RIPASA vs MA scoring method, respectively. ConclusionsRIPASA score is highly efficacious and statistically significant in diagnosing acute appendicitis with higher PPV at higher scores and higher NPV with lower scores leading to decreased NAR compared with MA score.