Prithivi Raja, K (2020) To Determine Validation of RIPASA Score in Diagnosis of Suspected Acute Appendicitis and Histopathological Correlation. Masters thesis, Government Vellore Medical College, Vellore.
|
Text
220122120prithivi_raja.pdf Download (3MB) | Preview |
Abstract
INTRODUCTION: Appendicitis is the most common emergent surgical operation performed with incidence of about 6 – 7% in general population. It is mostly common in second decade of life .diagnosis of acute appendicitis is challenging and needs high index of suspicion by operating surgeon to reduce morbidity and mortality. It is less common in under developed countries which suggest low fiber diet; high fat intake may play a role in disease. There are various scoring system used till now in diagnosing appendicitis which are Alvarado, modified Alvarado scoring system till now which has poor sensitivity and specificity. RIPASA score has been developed for the diagnosing acute appendicitis. This score is focussed on 14 clinical parameters. Presenting symptoms. (5 symptoms), patient demographic (age and gender), clinical signs (5 signs), Laboratory investigations (elevated wbc count and negative urinalysis). This study was to evaluate RIPASA score in diagnosing acute appendicitis and correlating histo pathologically. AIMS AND OBJECTIVES: To evaluate RIPASA score in diagnosis of acute appendicitis and correlating histo-pathologically. MATERIALS AND METHODS: A prospective study was conducted in Government Vellore Medical College, Department of General Surgery from November 2018 to July 2019. one hundred patients presented with right iliac fossa pain in emergency or in out patient department and suspected to have acute appendicitis were included. Proforma was filled for all 100 patients which includes general information of patients, eight variables based on RIPASA score. Score was calculated divided into four groups. Diagnosis was confirmed by intra op finding and histopathological assessment. Reliability of RIPASA score is assessed by calculating sensitivity, specificity, positive predicitive value and negative predictive value. INCLUSION CRITERIA: 1. Patients presenting to emergency department with signs and symptoms suggestive of acute appendicitis. 2. Age 15-59, 3. Both sex. EXCLUSION CRITERIA: Age below 15 yrs and above 60 yrs, Lump in right iliac fossa, Trauma history, Pregnant females, Urolithiasis patients and females with pelvic inflammatory disease. Total score - < 5.0 : chances appendicitis are very less (almost nil). patient observed in ward and recalculate score after 1 or 2 hr. Total score -5.0-7.0- appendicitis probability is very low, patient observed in ward and repeat scoring after 1 or 2 hr or perform radiological investigation. Total score – 7.5-11.5- appendicitis probability is very high. Patient admitted and repeat score after 1 or 2 hr and if it remains surgery is indicated. In females patients usg done to exclude gynaecological causes of RIF pain. Total score > 12- Appendicectomy. RESULTS: M : F ratio was 1.12 : 1. More number of patients were noticed in the age group of 21 – 30 yrs and less number in 51 – 60 yrs. Pain in right iliac fossa was mostly observed symptom and RIF tenderness was most common sign observed. RIPASA SCORE of < 5 is observed in 6 patients, 5-7 in 17 patients, 7.5-11.5 in 69 patients, > 12 in 8 patients.77 patients were operated with duty surgeons decision and out of which 26 patients had acute appendicitis and 38 patients had appendicular perforation and 12 had normal appendix on histopathological report .Sensitivity of RIPASA score was about 91% and specificity is 60%. Positive predictive value is 85% and negative predictive value is 73% .Negative appendectomy rate was about 11%. CONCLUSION: RIPASA score is a simple, safe , easy and non-invasive new diagnostic tool in diagnosing acute appendicitis especially in rural population who are in low and middle socioeconomic class where radiological diagnostic tools are not easily available .Also has higher sensitivity , specificity and diagnostic accuracy in comparing to alvardo and modified alvardo score.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 201711659 |
| Uncontrolled Keywords: | Determine Validation, RIPASA Score, Diagnosis of Suspected Acute Appendicitis, Histopathological Correlation. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Feb 2021 17:52 |
| Last Modified: | 12 Feb 2021 17:52 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14081 |
Actions (login required)
 |
View Item |
