How do you diagnose appendicitis? An international evaluation of methods
Bibliographic record
Abstract
INTRODUCTION: Considerable variability exists in the diagnostic approach to acute appendicitis (in children), affecting both quality and costs of care. Interestingly, an international evaluation of what is commonly practiced today has not been performed. We aimed to document current practice patterns in the diagnosis of appendicitis in children and to determine whether a consensus exists in the workup of these patients among Canadian, Dutch, and Saudi Arabian pediatric surgeons. METHODS: We performed a cross-sectional survey using a pre-designed, self-administered, 14-item survey. We sent the survey to participants via electronic mail. RESULTS: In total, 83 responses were received and analyzed, yielding a response rate of 42%. The majority of respondents practiced at pediatric surgery centers with over 50 beds (58% of Canadian surgeons, 81% of Dutch surgeons, 93% of Saudi Arabian surgeons). The majority of Dutch surgeons had a preference for physical examination and radiological imaging as opposed to Canadian and Saudi Arabian surgeons who favored history and physical examination. Interestingly, only one of the surgeons surveyed used an appendicitis scoring system. Regarding history and physical examination, most respondents deemed migratory abdominal pain and localized RLQ tenderness to be most suggestive of appendicitis. Ultrasound was the most preferable imaging modality in acute appendicitis across all three countries. CONCLUSION: This study demonstrates that international pediatric surgeons vary substantially in the diagnostic workup of patients with appendicitis. Furthermore, there is a variability between common practice and the current evidence. We recommend that pediatric surgeons develop clinical practice guidelines that are based on consensus information (expert opinion) and the best available literature.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".