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

Biostratigraphy and evolution o/Microtus brecciensis from the Pleistocene sites of Atapuerca (Burgos, Spain)

The stratìgraphic correlation and the chronometricals datums obtained in the levels from the karstic fillings of Atapuerca, enable us to see a paleontologie record of Microtus brecciensis since last episodes of Lower Pleistocene till the end of the Middle Pleistocene, and a evolutive trend to increase size through this tim

Terrícola a tapuerquensis. (arvicolidae, rodentia) a new species from Middle Pleistocene of Atapuerca (Burgos, España)

A new species of ARVICOLIDAE, Terricola atapuerquensis. is described in [fie upper levels of Middle Pleistocene from the Trincherà del Ferrocarril of Atapuerca (Burgos.Spain

Los castores del Pleistoceno medio de Atapuerca (Burgos, España)

This work is a description of the Castor fiber fossi/s remains found in the Karst fillings of Atapuerca (Burgos, Spain

Los múridos del Pleistoceno medio de Atapuerca (Burgos, España). Distribución estratigráfica

This work is a description of the MURIDAE fossils remains found in the karst fillings of Atapuerca (Burgos, Spain) and their stratigraphical distributio

Micromammals from the lower-middle Pleistocene bocendary from Atapuerca (Burgos, Spain). Biostratigraphycal and evolutive implications

The micromammals association of the TD5- TD6 levels is exclusive from the karstic complex of Atapuerca (Burgos, Spain). This association is characterized by the presence of arvicolids : Terricola gregaloides, Terricola huescarensis, Terricola subterraneus, Microtus brecciensis, Arvicola chalirei, Mimorriys savini, Pliomys episcopalis, together two new rodent species: Terricola seseae nov. sp. and Microtus iignani nov. sp.. This fauna seems to correspond to the transit Lower Pleistocene - Middle Pleistocene, with more than 780.000 years ago, near of Matuyama/ Brunhes boundar

Presence of Marmota marmota in Atapuerca (Burgos, Spain) Karstic fillings

In this work are described the more old fossil record of Marmota marmota of the european Pleistocene, in the levels of Lower Pleistocene (TD6), and Middle Pleistocene (TN4, TD10) from the Trinchera del Ferrocarril of Atapuerca (Spain

Los roedores del yacimiento musteriense de la Cueva de Gabasa (Pirineo Aragonés), Interés paleoecológico

The rodents of the Mousterian site Cueva de Gabasa (province of Huesca) have been studied in this report. The stratigraphical distribution of rodents has a paleoecological meaning in the karstic sit

Megaplanolites ibericus: a new contribution to geological heritage of Aragon

Las especiales características del yacimiento paleontológico de Megaplanolites ibericus en las proximidades de Bueña(Teruel) permiten considerarlo como parte del patrimonio geológico de AragónThe special characteristicals of the paleontological site of Megaplanolites ibericus> near of Bueña (province of Teruel), allow consider such as Geological heritage of Arago

Considerations about the didactical ofpaieoecological recostructions and your problems in the high school

This work is an analysis of Ceo/ogy and Biology text for high school ofpaleoecologycal reconstruction, and it is included a conceptual map to make the sequence contents in the design of didactical units in order to approach this subjet