Objective:

To compare the Alvarado scale, RIPASA, and a new proposal to evaluate which is the most accurate in the early diagnosis of acute appendicitis.

Setting:

Hospital General de Atizapán, ISEM.

Design:

Prospective, cross-sectional, comparative and observational study.

Statistical analysis:

Measures of central tendency, analysis for diagnostic tests (sensitivity, specificity, predictive values) and ROC curve.

Patients and methods:

In the General Hospital of Atizapán (Period: November 2016-October 2017) the 182 patients that were studied entered in the emergency room with suggestive abdominal pain syndrome of acute appendicitis. Applying simultaneously Alvarado scale, RIPASA, and a new scale. General epidemiological, clinical and surgical findings were noted correlating them with the result of histopathology of the appendix as well as post-surgical evaluation and complication rate.

Results:

Taking the high scores of each scale applied in patients was obtained that the sensitivity of Alvarado was 81% with a positive predictive value of 70%, from RIPASA 88% with positive predictive value 92% and the scale proposed sensitivity is 91% with positive predictive value of 98%. The area under the ROC curve of the scale of Alvarado was 0.83, RIPASA was 0.85, and new proposal scale was 0.92.

Conclusions:

The three scales showed good sensitivity in the diagnosis of acute appendicitis. However the proposed new scale is more exact in the diagnosis, with a much higher positive predictive index, favoring not only less white laparotomy but even an earlier and timely diagnosis with lower rate of advanced phases and complications.

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