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

Patient-Centered Outcomes of an Emergency Department Social and Medical Resource Intervention

Introduction: Few studies have examined the impact of emergency department (ED) social interventions on patient outcomes and revisits, especially in underserved populations. Our objective in this study was to characterize a volunteer initiative that provided community medical and social resources at ED discharge and its effect on ED revisit rates and adherence to follow-up appointments at a large, county hospital ED. Methods: We performed a cross-sectional analysis of ED patients who received medical and social resources and an educational intervention at discharge between September 2017–June 2018. Demographic information, the number of ED return visits, and outpatient follow-up appointment adherence within 30 and 90 days of ED discharge were obtained from electronic health records. We obtained data regarding patient utilization of resources via telephone follow-up communication. We used logistic regression analyses to evaluate associations between patient characteristics, reported resource utilization, and revisit outcomes.&nbsp;&nbsp; Results: Most patients (55.3% of 494 participants) identified as Latino/Hispanic, and 49.4% received healthcare assistance through a local governmental program. A majority of patients (83.6%) received at least one medical or social resource, with most requesting more than one. Patients provided with a medical or social resource were associated with a higher 90-day follow-up appointment adherence (odds ratio [OR] 2.56; 95% confidence interval [CI] 1.05-6.25, and OR 4.75; 95% CI 1.49-15.20], respectively), and the provision of both resources was associated with lower odds of ED revisit within 30 days (OR 0.50; 95% CI 0.27-0.95). Males and those enrolled in the healthcare assistance program had higher odds of ED revisits, while Hispanic/Latino and Spanish-speaking patients had lower odds of revisits. Conclusion: An ED discharge intervention providing medical and social resources may be associated with improved follow-up adherence and reduced ED revisit rates in underserved populations

Infrared satellite observations of hydrogen sulfide in the volcanic plume of the August 2008 Kasatochi eruption

Hydrogen sulphide (H2S) is one of the main trace gases released from volcanoes with yearly global emissions estimated between 1 and 37 Tg. With sulfur dioxide (SO2, 15-21 Tg/year), it dominates the volcanic sulfur budget, and the emission ratio H2S:SO2 is an important geochemical probe for studying source conditions, sulfur chemistry and magma-water interactions. Contrary to SO2, measurements of H2S are sparse and difficult. Here we report the first measurements of a large H2S plume from space. Observations were made with the infrared sounder IASI of the volcanic plume released after the 7-8 August 2008 eruption of Kasatochi volcano. The eruption was characterized by 5 consecutive explosive events. The first events were phreatomagmatic producing a plume rich in water vapor and poor in ash and SO2. We show that the observed H2S plume, calculated at 29 +/- 10 kT with integrated columns exceeding 140 +/- 25 Dobson Units (DU), is likely associated with these first explosions. H2S:SO2 ratios with maximum values of 12 +/- 2 are found, representative of redox conditions in the hydrothermal envelop. With a detection threshold of 25 DU, future space observations of H2S plumes are certain. These will be important for improving the atmospheric sulfur budget and characterizing the H2S:SO2 fingerprint of different eruptions.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe