Evaluation of concordance among surgeons and pathologists regarding the diagnosis and classification of acute appendicitis in children
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In brief
In brief
Study of 1092 pediatric appendectomy cases reveals only moderate concordance (kappa 0.7) between surgeons' intraoperative assessment and pathologists' histological classification of perforated versus non-perforated appendicitis. Diagnostic agreement was independent of surgeon experience or surgical approach, with minimal clinical impact from discordant cases.
Written by the GCMD Library team from the article.
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