Observing and rescoring equivocal appendicitis sorted patients for CT better than a single score

The edition in brief

In 83 adults with early equivocal appendicitis observed in the DIAMOND trial, the change in Adult Appendicitis Score over a short observation period discriminated appendicitis far better than the baseline score (AUROC 0.93 vs 0.63). A fall of 2 or more points gave a negative predictive value of 97%, and a rise of 1 or more a positive predictive value of 94%, leaving an intermediate group for imaging. The sample is small and single-trial, but it supports observe-and-rescore before CT. In the CorCMR trial, 250 patients with angina and no obstructive coronary disease were randomised to stress perfusion cardiac MRI-guided endotype-specific treatment or usual care; illness perception improved by about 11 points at 12 months and PHQ-4 distress scores fell by about 1 point. In 1,154 patients with transfusion-dependent thalassaemia, right ventricular–pulmonary arterial coupling on cine MRI tracked iron burden and was independently associated with heart failure (OR 3.99, p = 0.049). Photon-counting CT matched MRI for breast lesion characterisation and was more sensitive for nodal metastasis, but missed 44% of microcalcifications seen on mammography. Six US societies called for mandatory adoption of enhanced radiation protection devices in fluoroscopy laboratories. The pearl: distance is the cheapest shielding.