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Objectives <p>Clinical scoring systems are frequently used to support decision-making in suspected acute appendicitis; however, their value for severity stratification is less well defined. We compared the diagnostic performance of the Alvarado, RIPASA, and Lintula scores in a surgically managed adult cohort and examined their relationship with histopathological subtypes.</p> Methods <p>This retrospective observational study included 312 adults who underwent appendectomy for suspected acute appendicitis between May 2024 and April 2025 at Amasya University Şerefeddin Sabuncuoğlu Training and Research Hospital. Clinical variables recorded at emergency department presentation were used to derive Alvarado, RIPASA, and Lintula scores, which were calculated retrospectively from chart data. Histopathology served as the reference standard. Using literature-recommended cutoffs, sensitivity, specificity, positive and negative predictive values (PPV and NPV), accuracy, and the Youden index were calculated. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC).</p> Results <p>Mean age was 29.77 ± 9.55 years, and 58.7% were male. Laparoscopic appendectomy was performed in 97.8% of cases. Appendicitis was confirmed histologically in 90.1%, with phlegmonous (49.4%), gangrenous (22.4%), and perforated (18.3%) subtypes; the negative appendectomy rate was 9.9%. At standard thresholds, sensitivity/specificity were 67.3%/71.0% (Alvarado), 76.1%/77.4% (RIPASA), and 70.1%/64.5% (Lintula). PPV was high (94.7%–96.8%), whereas NPV was low (19.2%–26.4%). AUC values were 0.765, 0.857, and 0.829 for Alvarado, RIPASA, and Lintula, respectively. Mean scores increased with histopathological severity (p &lt; 0.001). In perforation-focused analysis, RIPASA showed the highest AUC (0.922).</p> Conclusions <p>In this surgically managed cohort, positive test results were associated with histologically confirmed appendicitis; however, interpretation of predictive values should take into account the high-prevalence, surgically selected nature of the study population. RIPASA showed the highest observed overall AUC and favourable performance in perforation-focused analysis. Nevertheless, the consistently low NPV limits the utility of these scores as standalone rule-out tools, and clinical scoring systems should be interpreted alongside clinical assessment and imaging.</p>

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Comparative diagnostic performance of Alvarado, RIPASA, and Lintula scores in surgically managed adults with suspected acute appendicitis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月15日

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  • Suat Evirgen,
  • Yasin Duran,
  • Önder Karabay

摘要

Objectives

Clinical scoring systems are frequently used to support decision-making in suspected acute appendicitis; however, their value for severity stratification is less well defined. We compared the diagnostic performance of the Alvarado, RIPASA, and Lintula scores in a surgically managed adult cohort and examined their relationship with histopathological subtypes.

Methods

This retrospective observational study included 312 adults who underwent appendectomy for suspected acute appendicitis between May 2024 and April 2025 at Amasya University Şerefeddin Sabuncuoğlu Training and Research Hospital. Clinical variables recorded at emergency department presentation were used to derive Alvarado, RIPASA, and Lintula scores, which were calculated retrospectively from chart data. Histopathology served as the reference standard. Using literature-recommended cutoffs, sensitivity, specificity, positive and negative predictive values (PPV and NPV), accuracy, and the Youden index were calculated. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC).

Results

Mean age was 29.77 ± 9.55 years, and 58.7% were male. Laparoscopic appendectomy was performed in 97.8% of cases. Appendicitis was confirmed histologically in 90.1%, with phlegmonous (49.4%), gangrenous (22.4%), and perforated (18.3%) subtypes; the negative appendectomy rate was 9.9%. At standard thresholds, sensitivity/specificity were 67.3%/71.0% (Alvarado), 76.1%/77.4% (RIPASA), and 70.1%/64.5% (Lintula). PPV was high (94.7%–96.8%), whereas NPV was low (19.2%–26.4%). AUC values were 0.765, 0.857, and 0.829 for Alvarado, RIPASA, and Lintula, respectively. Mean scores increased with histopathological severity (p < 0.001). In perforation-focused analysis, RIPASA showed the highest AUC (0.922).

Conclusions

In this surgically managed cohort, positive test results were associated with histologically confirmed appendicitis; however, interpretation of predictive values should take into account the high-prevalence, surgically selected nature of the study population. RIPASA showed the highest observed overall AUC and favourable performance in perforation-focused analysis. Nevertheless, the consistently low NPV limits the utility of these scores as standalone rule-out tools, and clinical scoring systems should be interpreted alongside clinical assessment and imaging.