Background: Clinical scoring systems are increasingly used in emergency departments for decision support and risk stratification. This prospective observational study evaluated the diagnostic performance of the RIPASA score in suspected acute appendicitis and explored its potential role as a structured decision-support tool within a training environment. Methods: We conducted a prospective observational study in a university emergency department including patients aged ≥ 18 years presenting with suspected acute appendicitis. The RIPASA score was calculated during routine clinical assessment by physicians with varying levels of experience. Histopathological findings served as the reference standard for operated patients, while non-operated patients were followed for one month. Diagnostic performance was assessed using receiver operating characteristic analysis. Results: Among 135 included patients (median age 28 years), acute appendicitis was confirmed in 55 cases (40.7%). The RIPASA score demonstrated moderate diagnostic accuracy, with an area under the curve of 0.79 (95% CI, 0.72– 0.87). The negative predictive value in the low-probability group reached 86.4%, whereas the positive predictive value in the high-probability group was 67.4%. Conclusion: The RIPASA score demonstrated moderate diagnostic performance for risk stratification in suspected acute appendicitis. While it may support structured clinical reasoning in training settings, it should not be used as a standalone tool for discharge decisions. Plain Language Summary: Clinical scoring systems help emergency doctors make decisions and train junior staff. This study evaluated the RIPASA score in patients with suspected appendicitis to see how well it works as a diagnostic and teaching tool. The score successfully grouped patients into low and high-risk categories. However, it was not reliable enough to be used alone to send patients home without further clinical review or tests. These results suggest that the RIPASA score provides a helpful structure for teaching clinical reasoning to young doctors, though more research is needed to measure its full educational impact. Keywords: appendicitis, clinical decision support, emergency medicine, medical education, risk assessment
Zaouche et al. (Sun,) studied this question.