Dear Sir,

We thank Dr. Tripoloni for taking the time to read our article “Diagnostic correlation of the RIPASA score in patients operated on for acute appendicitis” and for sending us his valuable observations. The responses to his corrections are listed below:

▪▪Although the sample size was not calculated, we decided to include the largest number of patients because our center mainly treats older adults (with a mean age of 63 years) and therefore, we do not have a high number of cases of acute appendicitis.

▪▪A p value ≤ 0.05 (95% CI) was considered statistically significant and all the calculations were performed using MedCalc version 19.1.3® statistical software package and Microsoft Excel 2016®. We used the Student’s t test to compare the duration of symptoms between the patients with and without acute appendicitis and without appendicitis in the pathology report.

▪▪The standard deviation of the duration of symptoms was 8.81 ± 3.41 hours for patients with acute appendicitis and 7.95 ± 4.32 for those without acute appendicitis.

▪▪One of the main shortcomings of this study is its retrospective nature and the fact that we relied on pathological anatomy samples for the definitive diagnosis. This paper was presented at the 89th Argentine Congress of Surgery and the judging panel criticized the fact that the score was not systematically applied to all the patients presenting at the emergency department with “right iliac fossa pain” as you indicated in the point 6; therefore, the potential discriminating function of the score was not achieved.

▪▪The electronic clinical records were analyzed by the lead author of the paper. We consider that the subjectivity of each treating surgeon at the time of the initial evaluation of the patient was the main bias. This bias could be reduced - as you said - by using more than one assessor in a prospective fashion.

▪▪The conclusion is based on the results and objectives of the study and not to the discussion as you propose.

Again, we emphasize the need for a prospective study with a sample size appropriate to the disease to validate its usefulness in our environment.