A systematic review of risk stratification for pediatric appendicitis
Bibliographic record
Abstract
PURPOSE: Disease risk stratification is essential for clinical decision-making, prognostication, and outcomes reporting. Pediatric appendicitis is typically described and treated as a binary entity of simple versus perforated, ignoring the wide variation in its presentation and outcomes. We performed a systematic review to assess and synthesize the available literature on risk stratification for pediatric appendicitis. METHODS: From inception to July, 2024, a comprehensive search of ten databases was conducted without language restrictions. We included any study that stratified pediatric appendicitis into three or more risk groups based on outcomes, using clinical, laboratory, imaging, surgical, or histopathologic criteria, or any combination of the five. Two independent reviewers performed the initial screening, with conflicts adjudicated by two additional reviewers. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Of 4,332 studies screened, 64 were selected for full-text evaluation, and seven met the inclusion criteria. The only prospective cohort study utilized a pediatric perforated appendicitis grade assigned at operation. Of the 6 retrospective studies, two employed the American Association for the Surgery of Trauma (AAST) classification, one described a surgeon-reported categorization, one used a pathology-defined appendicitis severity scale, and two multicenter studies used a set of binary (present or absent) findings. In all studies, increased postoperative infectious complications and hospital stays were seen in the higher-risk categories. CONCLUSIONS: Few pediatric appendicitis studies report risk-stratified outcomes with no widely accepted or utilized risk stratification system. A universal pediatric appendicitis grade is needed to improve clinical care, prognostication, benchmarking, outcomes reporting, and resource allocation.
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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 | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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".