Comparative Evaluation of RIPASA and Paediatric Appendicitis Score in Children with Acute Appendicitis

Abstract

Objective: To evaluate the diagnostic accuracy of Raja Isteri Pengiran Anak Saleha Appendicitis in children with acute appendicitis, and comparing its accuracy with Paediatric Alvarado score.

Method: The prospective, observational study was conducted at the Paediatric Surgery Department, Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from January 2024 to May 2025. Raja Isteri Pengiran Anak Saleha Appendicitis score and Paediatric Alvarado score were calculated in children presenting with right iliac fossa pain. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and area under receiver operating characteristic curve were obtained for both scores, and compared with the gold standard of histopathological findings. Data was analysed using SPSS 27.

Results: Of the 120 children with mean age 8.30±2.7 years, 87(72.5%) were boys and 33(27.5%) were girls. Negative appendectomy was noted in 12(10%) patients. Of them, 9(75%) patients had both low Raja Isteri Pengiran Anak Saleha Appendicitis and Paediatric Alvarado scores (p<0.001). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Raja Isteri Pengiran Anak Saleha Appendicitis score were 86.1%, 75.0%, 96.9%, 37.5% and 85%, respectively. The corresponding vales for Paediatric Alvarado score were 68.5%, 91.7%, 98.7%, 24.4% and 70.8%, respectively. For Raja Isteri Pengiran Anak Saleha Appendicitis score, the area under the receiver operating characteristic curve was 0.92. There was a significant association of Raja Isteri Pengiran Anak Saleha Appendicitis score with perforated appendicitis (p<0.05).

Conclusion: Raja Isteri Pengiran Anak Saleha Appendicitis was found to have a greater sensitivity and accuracy in diagnosing acute appendicitis in children, while Paediatric Alvarado score was more specific. With the help of Raja Isteri Pengiran Anak Saleha Appendicitis score, negative appendectomies in children may be avoided.

Key Words: Appendicitis, Children, RIPASA, PAS.