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Comment & Response
November 2017

Nonoperative Treatment of Appendicitis—Reply

Author Affiliations
  • 1Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
  • 2Laboratory of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
  • 3Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
JAMA Pediatr. 2017;171(11):1125-1126. doi:10.1001/jamapediatrics.2017.2946

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.

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