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

El problema del Estado y la literatura

La posibilidad de unos estudios ibéricos depende de su inventiva teórica tras desarmar el modelo que une Estado, nación y cultura en la historia social de la literatura, especialmente si se tiene en cuenta la compleja formación del Estado español en su relación con los territorios de la península. De este modo, cobrarían importancia los modos políticos en que la literatura interviene entre los aparatos de gobierno por fuera de sus mediaciones culturales oficiales. Sin embargo, al mismo tiempo es importante tener en cuenta su rol en la formación y la diseminación de una ideología del Estado. Esto implica una reflexión sobre el rol de la crítica literaria y una reconsideración de la noción de forma.The possibility of Iberian Studies depends on its theoretical inventiveness after disarming the model that unites state, nation and culture in the social history of literature, especially if the complex conformation of the Spanish state in its relation with the territories of the peninsula is taken into account. The political modes in which literature intervenes among government apparatuses outside its official cultural mediations would thus gain prominence. At the same time, it is important to take into account its role in shaping and disseminating a State ideology. This implies a reflection on the role of literary criticism and a reconsideration of the notion of form.Fil: Topuzian, Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Filosofía y Letras. Departamento de Letras; Argentin