Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Headache associated disability in medical students at the Kenyatta National Hospital, Nairobi

Objective: To study headache associated disability in a group of medical students at the Kenyatta National Hospital. Study design: Cross sectional survey. Results: Between October 1994 and January 1995 we conducted a survey on headache characteristics on medical students at both the Kenya Medical Training Centre and the Medical School of the University of Nairobi. Six hundred and twenty-five (87%) of the 711 students surveyed admitted having had at least one episode of headache in the last six months. Using the International headache society (IHS) case criteria 314 students (50%) had tension type headache, 240 (38%) migraine headache and 71 (12%) unclassified headache. Eighty-six percent of the students with headache had their working ability disturbed to various degrees. Eighty-five percent of the students reported that their social activities were interfered with by headache. Migraine headaches had the greatest impact on both the working and social activities at a p-value of 0.0005 and 0.0004 respectively. One hundred and forty-one students (23.6%) had missed at least one day of work or school in the last one-year as a direct result of the headache. There was an association between headache severity with working ability and social effect. There was no association between the days students missed work or classes with the severity of the headache. No gender difference was found in the headache associated disability. Conclusion: Headache is a prevalent condition with disability both in working and social activities. (East African Medical Journal: 2002 79(10): 519-523