Evaluation of concordance among surgeons and pathologists regarding the diagnosis and classification of acute appendicitis in children.

Abstract:

:Acute appendicitis is the most frequent urgent abdominal surgical pathology in children. Therapeutic decisions in patients who have undergone an appendectomy are made based on the macroscopic findings at the moment of surgery. There is high variability between surgical and histopathological findings. METHOD:Concordance among surgeons and pathologists regarding the diagnosis and classification of acute appendicitis was assessed in children who have undergone an appendectomy. Surgical site infection (SSI) incidence was measured for both the surgical and pathological classification. RESULTS:The statistical analysis included 1092 children. The pathologists confirmed the presence of appendicitis in 90.4% of the patients. Concordance in the diagnosis of appendicitis among surgeons and pathologists was weak (kappa 0.57), while concordance in the classification of perforated or non-perforated appendicitis was moderate (kappa 0.7). There were no significant differences in these findings determined by the surgeons' experience or the open or laparoscopic approach. In the discordant group of 70 patients in which the surgeon classified the appendicitis as non-perforated but the pathologist classified as perforated, just one patient developed an intra-abdominal abscess. CONCLUSIONS:The classification of appendicitis as perforated or non-perforated shows moderate concordance between the surgical and histopathological diagnosis. This concordance is not determined by the surgeons' experience or the surgical approach. TYPE OF STUDY:Diagnostic Test LEVEL OF EVIDENCE: Level II.

journal_name

J Pediatr Surg

authors

Rodríguez E,Valero J,Jaramillo L,Vallejo-Ortega MT,Lagos L

doi

10.1016/j.jpedsurg.2019.09.025

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

1503-1506

issue

8

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(19)30677-3

journal_volume

55

pub_type

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