In Reply We appreciate the attention, comments, and questions on our article1 in JAMA Pediatrics. Regarding Bonadio’s first question, we would agree that criteria for adults are not always applicable for children. The references Bonadio cited, which showed nonappendicitis had a normal measured appendiceal diameter of greater than 6 mm, were adult-based studies. For children, 6 mm is a critical diagnostic criterion for acute appendicitis (AA).2 Meanwhile, diagnosis for AA is mainly based on clinical findings combined with imaging examination. The inclusion criteria of studies were comprehensive; appendiceal dilation as 6 to 11 mm is part of the criteria, which was defined to exclude either complicated appendicitis or normal appendix. But it could be possible that nearly normal or milder appendicitis be included in nonoperative treatment (NOT) group, so risk-stratified scoring system3,4 should be used for ultrasonography examination, providing more detailed information for the precision diagnosis of AA.
Huang L, Li Y, Zhou Z. Nonoperative Treatment of Appendicitis—Reply. JAMA Pediatr. 2017;171(11):1125–1126. doi:10.1001/jamapediatrics.2017.2946
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