Comment on article entitled “The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population”

Dear Editor:

It was a great pleasure to read the article “The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population” by Malik et al. [1]. Preoperative diagnosis of acute appendicitis is one of the great enigmas of surgery so much so that doing negative appendectomies is an acceptable term and a high percentage of negative appendectomies (20%) is regarded as reasonable [2]. In 2014, we did an audit of our results on appendectomy in the form of a cross-sectional retrospective study that was conducted using hospital database that reviewed all appendectomies in our department at Rajendra Institute of Medical Sciences, Ranchi, in a two-year period (2013–2014). There were a total of 210 appendectomies performed: all open procedures. Regarding the pathological outcome of the operation, negative appendectomy rate (NAR) was 18% (38 patients). We seldom use contrast-enhanced computed tomography for diagnosing acute appendicitis. Most of the cases are diagnosed on clinical examination and ultrasonography of abdomen. New scoring systems keep on coming to accurately predict the diagnosis of acute appendicitis, but how significantly they alter the management is strongly debatable. One of the major limitations of this article is that authors have not compared the RIPASA score with Alvarado score in the same cohort. Negative appendectomy rate is also higher in this study. Since this is a retrospective study, authors could not conclude whether use of a RIPASA scoring system will be helpful in decreasing the negative appendectomy rate since decreasing the financial burden and morbidity arising due to negative appendectomies is an issue. Hence, it will be interesting to see if authors plan to do this study in a prospective cohort.

References

  1. 1.

    Malik MU, Connell TM, Awan F, Pretorius F, Fiuza-Castineira C, El Faedy O, Balfe P (2016) The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population. Int J Color Dis. doi:10.1007/s00384-016-2713-4

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  2. 2.

    Toorenvliet BR, Wiersma F, Babker RF et al (2010) Routine ultrasound and mimited computed tomography for the diagnosis of acute appendicitis. World J Surg 34(10):2278–2285

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Correspondence to Sanjay Kumar Yadav.

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Chandra, G., Shekhar, A., Kumar, R.R. et al. Comment on article entitled “The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population”. Int J Colorectal Dis 32, 761 (2017). https://doi.org/10.1007/s00384-017-2764-1

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Keywords

  • Compute Tomography
  • Retrospective Study
  • Open Procedure
  • Clinical Examination
  • Prospective Cohort