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

Convergence angles for full veneer crown preparation completed by undergraduate students in a dental teaching hospital

Objectives: To determine the degree of taper and the average angle of convergence (AOC) accomplished for full veneer/coverage crowns (FVC) by supervised undergraduate students at a dental teaching hospital. Methods One hundred and twenty-five stone dies of FVC preparations (25 full-metal [FMCs] and 100 metal-ceramic [MCCs]), prepared by dental students were included in this study. To measure AOC, standardised buccal and mesial photographs were taken when dies were mounted onto a custom silicone jig after careful positioning. 2D digital analysis software (ImageJ) was used to calculate the average mesio-distal (MD), bucco-lingual (BL) and overall AOC for each die. Differences between groups were tested for significance at 95% confidence using t-tests and analysis of variance (ANOVA). Findings were compared to the recommended 6°–15° range. Results: The average AOC was 24.2° ± 11.95°. As few as one-in-four preparations (26.4%, n = 33) complied with the recommended standards. The MD plane (24.7° ± 15.53°) was more tapered than the BL plane (23.0° ± 13.84°) (p >0.05) and FMCs preparations (34.7° ± 15.10°) more than MCCs (21.6° ± 9.38°) (p <0.001). Molars (31.6° ± 12.56°) had the greatest AOC, followed by premolars (20.7° ± 7.81°), canines (19.4° ± 6.37°) and incisors (17.0° ± 9.62°) (p <0.001). Additionally, mandibular teeth (28.8° ± 13.76°) exhibited a greater AOC than those in the maxilla (21.7° ± 10.08°) (p <0.05). Conclusion: The findings of this study suggest that within a dental school teaching environment, crown preparations completed by undergraduate students are over-tapered. Tooth type, inter and intra-arch position and crown material significantly impact taper, with mandibular molar FMCs displaying the greatest AOC. Contemporary dental school teaching should help support students in this important aspect of their clinical training