Professionals score pain lower than do children or guardians. Similar pain scores are obtained using both a Faces and a linear scale. This study offers no support for the introduction of a uniform pain assessment tool in a paediatric Emergency Department setting.

Evidence before this study: Acute appendicitis is the most common general surgical emergency in children. Its diagnosis remains challenging and children presenting with acute right iliac fossa (RIF) pain may be admitted for clinical observation or undergo normal appendicectomy (removal of a histologically normal appendix). A search for external validation studies of risk prediction models for acute appendicitis in children was performed on MEDLINE and Web of Science on 12 January 2017 using the search terms ["appendicitis" OR "appendectomy" OR "appendicectomy"] AND ["score" OR "model" OR "nomogram" OR "scoring"]. Studies validating prediction models aimed at differentiating acute appendicitis from all other causes of RIF pain were included. No date restrictions were applied. Validation studies were most commonly performed for the Alvarado, Appendicitis Inflammatory Response Score (AIRS), and Paediatric Appendicitis Score (PAS) models. Most validation studies were based on retrospective, single centre, or small cohorts, and findings regarding model performance were inconsistent. There was no high quality evidence to guide selection of the optimum model and threshold cutoff for identification of low-risk children in the UK and Ireland. Added value of this study: Most children admitted to hospital with RIF pain do not undergo surgery. When children do undergo appendicectomy, removal of a normal appendix (normal appendicectomy) is common, occurring in around 1 in 6 children. The Shera score is able to identify a large low-risk group of children who present with acute RIF pain but do not have acute appendicitis (specificity 44%). This low-risk group has an overall 1 in 30 risk of acute appendicitis and a 1 in 270 risk of perforated appendicitis. The Shera score is unable to achieve a sufficiently high positive predictive value to select a high-risk group who should proceed directly to surgery. Current diagnostic performance of ultrasound is also too poor to select children for surgery. Implications of all the available evidence: Routine pre-operative risk scoring could inform shared decision making by doctors, children, and parents by supporting safe selection of lowrisk patients for ambulatory management, reducing unnecessary admissions and normal appendicectomy. Hospitals should ensure seven-day-a-week availability of ultrasound for medium and high-risk patients. Ultrasound should be performed by operators trained to assess for acute appendicitis in children. For children in whom diagnostic uncertainty remains following ultrasound, magnetic resonance imaging (MRI) or low-dose computed tomography (CT) are second-line investigations.

We have confirmed a relationship between increasing dose of thioridazine and prolongation of QTc in overdose patients. No such change was observed with chlorpromazine. Both of these agents are reported to cause QT prolongation, but this study suggests that the nature of these effects is different for each agent. Poisoned patients may offer ways of exploring in more detail, and at a larger dose range, the effects of potentially cardiotoxic drugs in humans.

Aim The cosmetic surgery industry continues to grow, both within the UK and internationally. There is a perception that the NHS is often left to deal with the complications of these procedures, particularly those performed abroad. This study aimed to evaluate the burden of cosmetic surgery complications on a tertiary London plastics service with an appraisal of the financial costs incurred. Method This one-year retrospective service evaluation included all emergent referrals following cosmetic surgical interventions in the UK private sector and abroad. Outpatient referrals and planned revisional procedures were excluded. Financial costs were based upon current Clinical Commissioning Group tariffs. Results In total, 14 patients were included (seven from the UK and seven from Europe or North Africa). Remote telemedicine advice was provided for six patients; eight patients required admission. All eight admissions were female with an average age of 42.6 years. The most common complication was infection (75%) with an average length of stay of 2.3 nights. These eight patients required six trips to theatre, two CT scans and 37 outpatient visits. The median tariff per patient was £1,510 (range £242 to £5,196), leading to an overall reimbursement of £16,471. The majority of these costs were generated during inpatient admissions (£12,855) with a lesser contribution from outpatient episodes (£3,616). Conclusions This project provides an overview of the impact of managing emergent complications following cosmetic surgery, both in terms of service activity and financial cost. A long-term, prospective service evaluation of both elective and emergency referrals based upon patient-level costing data is now underway.