Refinement of the Ramcho Score: the unadjusted impact of body-mass index and pre-hospital medications
Abstract
This letter discusses the recently proposed Ramcho Score for differentiating acute diverticulitis from epiploic appendagitis. While the scoring system offers a valuable, cost-effective diagnostic tool, I highlight the potential confounding influence of metabolic factors, specifically obesity and body mass index (BMI), and pre-hospital use of anti-inflammatory medications. Given that adipose tissue is metabolically active and can elevate inflammatory markers used in the score, and that analgesics may blunt these responses, I suggest that future validation of this score should adjust for these variables to ensure its clinical generalizability and specificity.
Keywords
Supporting Institution
None.
Ethical Statement
Not applicable.
Thanks
None.
References
- Şahin F, Topcu R, Tutan MB. The role of laboratory parameters in discriminating between acute diverticulitis and acute epiploic appendagitis: a comprehensive analysis. J Med Palliat Care. 2026;7(1):71-78. doi:10.47582/jompac.1844986
- Schnedl WJ, Krause R, Tafeit E, Tillich M, Lipp RW, Wallner-Liebmann SJ. Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 2011;8(1):45-49. doi:10.1038/nrgastro.2010.189
- Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282(22):2131-2135. doi:10.1001/jama.282.22.2131
- Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. gastroenterology. 2019;156(5):1282-1298.e1. doi:10.1053/j.gastro.2018.12.033
- Ridker PM. Cardiology Patient Page. C-reactive protein: a simple test to help predict risk of heart attack and stroke. Circulation. 2003;108(12): e81-85. doi:10.1161/01.CIR.0000093381.57779.67
Details
Primary Language
English
Subjects
Gastroenterology and Hepatology
Journal Section
Letter to Editor
Authors
Publication Date
June 25, 2026
Submission Date
February 28, 2026
Acceptance Date
April 13, 2026
Published in Issue
Year 2026 Volume: 7 Number: 3
APA
Takahashi, K. (2026). Refinement of the Ramcho Score: the unadjusted impact of body-mass index and pre-hospital medications. Journal of Medicine and Palliative Care, 7(3), 643-644. https://izlik.org/JA44LZ57TK
AMA
1.Takahashi K. Refinement of the Ramcho Score: the unadjusted impact of body-mass index and pre-hospital medications. J Med Palliat Care / JOMPAC / jompac. 2026;7(3):643-644. https://izlik.org/JA44LZ57TK
Chicago
Takahashi, Koji. 2026. “Refinement of the Ramcho Score: The Unadjusted Impact of Body-Mass Index and Pre-Hospital Medications”. Journal of Medicine and Palliative Care 7 (3): 643-44. https://izlik.org/JA44LZ57TK.
EndNote
Takahashi K (June 1, 2026) Refinement of the Ramcho Score: the unadjusted impact of body-mass index and pre-hospital medications. Journal of Medicine and Palliative Care 7 3 643–644.
IEEE
[1]K. Takahashi, “Refinement of the Ramcho Score: the unadjusted impact of body-mass index and pre-hospital medications”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 3, pp. 643–644, June 2026, [Online]. Available: https://izlik.org/JA44LZ57TK
ISNAD
Takahashi, Koji. “Refinement of the Ramcho Score: The Unadjusted Impact of Body-Mass Index and Pre-Hospital Medications”. Journal of Medicine and Palliative Care 7/3 (June 1, 2026): 643-644. https://izlik.org/JA44LZ57TK.
JAMA
1.Takahashi K. Refinement of the Ramcho Score: the unadjusted impact of body-mass index and pre-hospital medications. J Med Palliat Care / JOMPAC / jompac. 2026;7:643–644.
MLA
Takahashi, Koji. “Refinement of the Ramcho Score: The Unadjusted Impact of Body-Mass Index and Pre-Hospital Medications”. Journal of Medicine and Palliative Care, vol. 7, no. 3, June 2026, pp. 643-4, https://izlik.org/JA44LZ57TK.
Vancouver
1.Koji Takahashi. Refinement of the Ramcho Score: the unadjusted impact of body-mass index and pre-hospital medications. J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Jun. 1;7(3):643-4. Available from: https://izlik.org/JA44LZ57TK
