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

Mild Cognitive Impairment

Mild cognitive impairment (MCI), a heterogeneous disorder, is frequently diagnosed by geriatricians and neurologists and is a hot topic in research. MCI refers to cognitive impairment that is worse than would be expected on the basis of age but which does not meet the criteria for dementia. The diagnosis is based on the patient history and an interview with an informant, preferably supplemented with objective tests to establish the cognitive status of the patient. MCI is an important risk factor for the development of dementia: annually 5-15% of patients with MCI develop dementia. There is currently no treatment for MCI, but it is important to treat possible organic factors. For now, it is important for the general practitioner to know the background of diagnosed MCI or reported mild cognitive problems, and to support and guide patients and their relatives. There is no added benefit to the general practitioner making the diagnosis.</p