The effectiveness of the Raja Isteri Pengiran Anak Saleha Appendicitis Score in the diagnosis of acute appendicitis in elderly patients

Acute appendicitis (AA) is the most common cause of acute abdominal surgeries, accounting for 15% of all emergency visits due to acute abdominal pain in patients aged over 60 years. Appendicitis is reported as the third most common cause of abdominal surgery in geriatric patients. In this current retrospective study, the records of 68 patients aged over 65 years, who were treated by surgical resection in our clinic diagnosed for AA between February 2015 and February 2020, were analyzed. The age, gender, duration of hospital stay of the patients and, histopathological results of appendectomy specimens were recorded. The Raja Isteri Pengrian Anak Saleha Appendicitis (RIPASA) Score of the patients was calculated according to the clinical history, physical examination, and laboratory parameters of the patients. According to the RIPASA scores, the patients were divided into three groups as the low-score group (4 to 7), the intermediate-score group (7.5 to 11.5), and the high-score group (≥ 12). The groups were compared on the basis of the microscopic diagnosis. According to the calculated RIPASA score, there were 12 patients in the low-score group, 44 patients in the intermediate-score group, and 12 patients in the high-score group. When the results were classified based on the pathology, we detected non-complicated conditions such as a normal appendix or reactive lymphoid hyperplasia in ten patients and catarrhal stage appendicitis in 38 patients along with complicated (gangrenous or perforated) appendicitis in 20 patients. In conclusion, the RIPASA score can be used in elderly patients considering its high accuracy rate. In elderly patients with a high RIPASA score, the pathological stage of the appendectomy specimen may also be complicated (perforated or gangrenous) appendicitis. Therefore, the mortality and morbidity rates may increase with increased complication rates.

Acute appendicitis; Elderly patients; Raja Isteri Pengiran Anak Saleha Appendicitis Score

[1] Karami MY, Niakan H, Zadebagheri N, Mardani P, Shayan Z, Deilami I. Which one is better? Comparison of the acute inflammatory response, Raja Isteri Pengiran Anak Saleha Appendicitis and alvarado scoring systems. Annals of Coloproctology. 2017; 33: 227-231.

[2] Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American Journal of Epidemiology. 1990; 132: 910-925.

[3] Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: study period 1993-2008. Journal of Surgical Research. 2012; 175: 185-190.

[4] Sheu B, Chiu T, Chen J, Tung M, Chang M, Young Y. Risk factors associated with perforated appendicitis in elderly patients presenting with signs and symptoms of acute appendicitis. ANZ Journal of Surgery. 2007; 77: 662-666.

[5] Dado G, Anania G, Baccarani U, Marcotti E, Donini A, Risaliti A, et al. Application of a clinical score for the diagnosis of acute appendicitis in childhood: a retrospective analysis of 197 patients. Journal of Pediatric Surgery. 2000; 35: 1320-1322.

[6] Siddiqui ZR, Khaliq T, Shah SA. A new simple scoring system for the diagnosis of acute appendicitis. Journal of Pakistan Medical Students. 2011; 1: 32-37.

[7] Chong CF, Adi MI, Thien A, Suyoi A, Mackie AJ, Tin AS, et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Medical Journal. 2010; 51: 220-225.

[8] Butt MQ, Chatha SS, Ghumman AQ, Farooq M. RIPASA score: a new diagnostic score for diagnosis of acute appendicitis. Journal of the College of Physicians and Surgeons. 2016; 24: 894-897.

[9] Kotaluoto S, Ukkonen M, Pauniaho S, Helminen M, Sand J, Rantanen T. Mortality related to appendectomy; A population based analysis over two decades in Finland. World Journal of Surgery. 2017; 41: 64-69.

[10] Riber C, Tønnesen H, Aru A, Bjerregaard B. Observer variation in the assessment of the histopathologic diagnosis of acute appendicitis. Scandinavian Journal of Gastroenterology. 1999; 34: 46-49.

[11] Karapolat B. Value of ultrasonography and the Raja Isteri Pengiran Anak Saleha Appendicitis Score in the diagnosis of acute appendicitis. ANZ Journal of Surgery. 2020; 90: 525-528.

[12] Eales L. Appendicitis and mimicking conditions. Lancet. 1976; 1: 704.

[13] Fagbohun CF, Toy EC, Baker B. The evaluation of acute abdominal pain in the elderly patient. Primary care update for OB/GYNS. 1999; 6: 181-185.

[14] Franz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. American Surgeon. 1995; 61: 40-44.

[15] Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine. 1986; 15: 557-564.

[16] Temple CL, Huchcroft SA, Temple WJ. The natural history of appendici-tis in adults. A prospective study. Annals of Surgery. 1995; 221: 278-281.

[17] Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Archives of Surgery. 2002; 137: 799-804.

[18] Nongmaithem M, Rathod S, Ali I, Bawa AS, Singh G, Mishra S. Evaluation of Raja Isteri Pengiran Anak Saleha Appendicitis Score: a new appendicitis scoring system. Medical Journal of Dr. D.Y. Patil University. 2015; 8: 744-749.

[19] Karapolat B. Can RIPASA scoring system predict the pathological stage of acute appendicitis? Emergency Medicine International. 2019; 2019: 8140839.

[20] Malik MU, Connelly TM, Awan F, Pretorius F, Fiuza-Castineira C, El Faedy O, et al. The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population. International Journal of Colorectal Disease. 2017; 32: 491-497.