A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

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

Population connectivity in the temperate damselfish\ud Parma microlepis: analyses of genetic structure across multiple spatial scales

This study investigated the utility of microsatellite markers for providing information on levels of population connectivity for a low dispersing reef fish in New South Wales (NSW), Australia, at scales ≤400 km. It was hypothesized that the temperate damselfish Parma microlepis, which produces benthic eggs and has limited post-settlement dispersal, would exhibit spatial genetic structure and a significant pattern of isolation-by-distance (IBD). A fully nested hierarchical sampling design incorporating three spatial scales (sites, location and regions, separated by 1–2, 10–50 and 70–80 km respectively) was used to determine genetic variability at seven microsatellite loci. Broad-scale genetic homogeneity and lack of IBD was well supported by single and multi-locus analyses. The proportion of the total genetic variation attributable to differences among regions, locations or sites was effectively zero (Φ/R-statistics ≤0.007). The geographic distribution of genetic diversity and levels of polymorphism (H E 0.21–0.95) indicate high mutation rates, large effective population sizes, and high rates of gene flow. Significant gene flow may be driven by factors influencing pre-settlement dispersal, including the East Australian Current (EAC) and habitat continuity. Genetic connectivity may not reflect demographically important connectivity, but does imply that P. microlepis populations are well connected from an evolutionary perspective. Total observed genetic diversity was accounted for within 1–2 km of reef and could be represented within small Marine Protected Areas. Reef fishes in NSW which have life histories similar to P. microlepis (e.g. pre-settlement durations ≥2 weeks) are also likely to exhibit genetic homogeneity. Genetic markers are, therefore, most likely to provide information on demographically relevant connectivity for species with lower dispersal capabilities, small population sizes, short life spans, and whose habitats are rare, or patchily distributed along-shore