Diagnostic accuracy of Alvarado, RIPASA and Tzanakis scoring system in acute appendicitis: A prospective observational study

Our prospective observational study, enrolling 167 patients undergoing emergency appendicectomy, served to evaluate the Alvarado, Tzanakis and RIPASA diagnostic scores. The latter was found to be a better scoring system because of its higher diagnostic accuracy. At centres with limited expertise in ultrasonography, RIPASA outperforms the Tzanakis score. Although easy to use, the Alvarado score was useful only to ‘rule in’ cases with AA with significant accuracy but at the cost of low sensitivity. It cannot be effectively used in triaging.

Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

Background Treatment patterns for cancer-associated venous thrombosis (CAT) has been shown to be nonconsistent with contemporary guideline recommendations, resulting in poor patient outcomes. Objectives The study aimed to describe contemporary CAT management in Danish oncology departments and identify knowledge gaps and inconsistencies between guidelines and clinical practice. Patients and Methods A survey questionnaire in Danish was developed based on contemporary national guidelines. Using an open recruitment strategy, invitations to participate in the electronic survey were sent to physicians employed at oncology departments in Denmark in winter of 2018/2019. The questionnaire was based on current national guidelines and included 10 items with multiple choices and a free-text option to specify or comment. The questionnaire was pilot-tested by a junior and senior oncologist. Results A total of 142 physicians completed the survey, representing all Danish geographical regions and various seniority. The majority reported that CAT was treated and followed up in oncology departments. However, 36.6% of the physicians were unaware of the existence of designated cancer thrombosis guidelines. Risk of venous thrombosis was generally assessed without diagnostic scores. Almost all (98.6%) reported low-molecular-weight heparin to be first-line treatment for CAT. Treatment duration seemed wrongly influenced by subtype of venous thrombosis, and 44.5% responded that thromboprophylaxis among hospitalized patients was substantially underused. Conclusion The variability in the daily clinical management of CAT demonstrated through this survey indicates a potential to increase awareness of available guidelines, standardized use of inpatient thromboprophylaxis, and organized treatment and follow-up in a multidisciplinary setting, which would potentially improve management of CAT in Denmark.

Difficulties in diagnosing and managing autoimmune hepatitis in low-income countries

The diagnosis of autoimmune hepatitis remains difficult in low-income countries due to the unavailability of the biopsy. autoimmune hepatitis must be retained on the basis of clinical-biological, radiological and immunological criteria. Careful trial corticosteroid therapy and diagnostic scores are essential for diagnostic autoimmune hepatitis.

Performance of diagnostic scores in thrombotic microangiopathy patients in the intensive care unit: a monocentric study

Early thrombotic thrombocytopenic purpura (TTP) recognition is critical as this disease is almost always lethal if not treated promptly with plasmatherapy. Currently, as ADAMTS13 activity is not widely available in emergency, scores have been developed to help differentiating TTP from other thrombotic microangiopathies (TMA). The aim of this work was to study the accuracy of these diagnostic scores in the ICU setting. Performance of both Coppo and PLASMIC scores was studied in a cohort of adult TMA patients requiring admission to one university hospital ICU from 2006 to 2017. ROC curves were established, confidence intervals of the AUC were determined. Multivariate logistic regression analysis was performed to identify parameters specifically associated with TTP, to compare diagnostic scores and to elaborate more accurate diagnostic models. During the study period 154 TMA patients required ICU admission, including 99 (64.2%) TTP and 55 (35.7%) non-TTP patients. AUC under ROC curve in predicting TTP was 0.86 (CI95% 0.81-0.92) for Coppo score, 0.67 (CI95% 0.58-0.76) for PLASMIC Score, and 0.86 [CI95% 0.81-0.92] for platelet count alone. A platelet count ≤20G/L, determined as the best cut-off rate for thrombocytopenia, performed similarly to Coppo score and better than PLASMIC score to differentiate TTP from non-TTP patients, both using AUC ROC curve and logistic regression. In a monocentric cohort of TMA patients requiring ICU admission, the PLASMIC score had limited performance for the diagnosis of TTP. The performance of the Coppo score was good but similar to a single highly discriminant item: platelet count ≤20G/L at admission.