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RIPASA Score

Raja Isteri Pengiran Anak Saleha Appendicitis Score — Validated for Asian Populations

A 16-point clinical scoring system specifically derived and validated in Asian populations, where the Alvarado score underperforms. Incorporates demographic factors (sex, age, nationality) and refined clinical signs.

General Surgery Acute Abdomen Appendicitis Asian Populations
RIPASA Score
Demographics
Symptoms
Signs
Investigations
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RIPASA Score (out of 16)
Enter values above and click Calculate

Score Interpretation

ScoreProbabilityRecommended Action
<5 Unlikely (<7%) Discharge with return-to-hospital advice
5–7.5 Low (~27%) Active observation and reassessment in 4–6 hours
7.5–11.5 High (~77%) Imaging or laparoscopic exploration
>11.5 Definite appendicitis Proceed to laparoscopic appendicectomy

Clinical Application

  • Derived in Brunei, Borneo (Chong et al. 2010) to address the systematic underperformance of Alvarado in Asian cohorts
  • Inclusion of demographic variables (age, sex, foreign nationality) reflects epidemiological differences in Asian emergency populations
  • Cut-off >7.5 gives sensitivity 88%, specificity 67% in Asian validation studies
  • At threshold >11.5: specificity approaches 90% — reliable trigger for theatre
  • Recommended by several Asian surgical societies as preferred score over Alvarado for South and Southeast Asian populations
  • Note: urinalysis "normal" scores +1 because pyuria/hematuria from proximity to ureter can be a misleading finding; normal UA increases specificity

Formula

Demographic (age, sex, nationality) + Symptoms (5 items) + Signs (5 items) + Investigations (2 items) = 0–16 points

References

  1. Chong CF, et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 2010;51(3):220–225.
  2. Chong CF, et al. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J. 2011;52(5):340–345.
  3. Butt MF, et al. Prospective study comparing the Alvarado and RIPASA scores to diagnose acute appendicitis. Ann Saudi Med. 2014.

Related Calculators

Alvarado Score AIR Score