{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:49:42Z","timestamp":1787870982388,"version":"build-2784847793"},"reference-count":17,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:00:00Z","timestamp":1772841600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Background<\/jats:title>\n Accurately predicting perforated appendicitis (PA) preoperatively remains challenging.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively studied appendectomy patients with histopathologically confirmed acute appendicitis (2022-2023) to identify predictors of perforation. The primary outcome was histopathologically confirmed perforated appendicitis. Bayesian univariate analysis and Bayesian logistic regression were performed to estimate risk probabilities, with frequentist analyses conducted for confirmation. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 770 patients with histologically confirmed appendicitis, 155 (20%) had PA. Bayesian univariate analysis demonstrated decisive evidence (BF\n 10<\/jats:sub>\n > 100) for several predictors, with C-reactive protein (CRP) (BF\n 10<\/jats:sub>\n = 251\u00a0079), age (BF\n 10<\/jats:sub>\n = 828), and lymphocyte percentage (BF\n 10<\/jats:sub>\n = 352) showing the strongest associations. Multivariate Bayesian modeling identified a parsimonious three-variable model comprising CRP, age, and lymphocyte percentage. This model demonstrated good discrimination (AUC 0.78) with high specificity (95.4%) and modest sensitivity (29%). Frequentist analyses confirmed these findings.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A predictive model incorporating CRP, age, and lymphocyte percentage provides a highly specific tool for ruling in perforated appendicitis. This approach may aid in prioritizing surgical urgency and optimizing perioperative management. Prospective validation is warranted.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/00031348261434243","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T15:11:14Z","timestamp":1773241874000},"page":"2031-2037","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Identifying Perforated Appendicitis Preoperatively: A Rule-In Risk Stratification Model"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1445-8680","authenticated-orcid":false,"given":"Edip","family":"Akpinar","sequence":"first","affiliation":[{"name":"SBU, Adana Faculty of Medicine"},{"name":"Adana City Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erhan","family":"G\u00f6k","sequence":"additional","affiliation":[{"name":"SBU, Adana Faculty of Medicine"},{"name":"Adana City Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-021-06077-5"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1308\/003588413X13511609958415"},{"issue":"11","key":"e_1_3_4_4_2","first-page":"273","article-title":"The pathology of the vermiform appendix and its relationship to clinical diagnosis","volume":"68","author":"Brady MP","year":"1975","unstructured":"Brady MP, Hennessy TP, Barrett J. The pathology of the vermiform appendix and its relationship to clinical diagnosis. Ir Med J. 1975;68(11):273-277.","journal-title":"Ir Med J"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.14744\/tjtes.2020.25741"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(86)90069-3"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0196-0644(86)80993-3"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/000313480707301017"},{"issue":"81","key":"e_1_3_4_9_2","first-page":"127","article-title":"Clinical and imaging characteristics relating to surgical outcomes of perforated appendicitis","volume":"55","author":"Tsai HM","year":"2008","unstructured":"Tsai HM, Shan YS, Lin PW, Lin XZ, Chen CY. Clinical and imaging characteristics relating to surgical outcomes of perforated appendicitis. Hepatogastroenterology. 2008;55(81):127-132.","journal-title":"Hepatogastroenterology"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.14744\/tjtes.2020.68246"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/08941939.2016.1241324"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-020-00928-x"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cursur.2006.06.008"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12920-016-0200-y"},{"key":"e_1_3_4_15_2","volume-title":"Theory of Probability","author":"Jeffreys H","year":"1961","unstructured":"Jeffreys H. Theory of Probability. 3rd ed. Oxford: Clarendon Press; 1961.","edition":"3"},{"issue":"3","key":"e_1_3_4_16_2","first-page":"142","article-title":"[The value of C-reactive protein and leucocyte count in preventing negative appendectomies]","volume":"7","author":"Eryilmaz R","year":"2001","unstructured":"Eryilmaz R, Sahin M, Alimo\u011flu O, Ba\u015f G, Ozkan OV. [The value of C-reactive protein and leucocyte count in preventing negative appendectomies]. Ulus Travma Derg. 2001;7(3):142-145.","journal-title":"Ulus Travma Derg"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2020.04.019"},{"issue":"11","key":"e_1_3_4_18_2","first-page":"1660","article-title":"Raftlin, presepsin levels and thiol-disulphide homeostasis in acute appendicitis: a pilot study","volume":"68","author":"Ozer OF","year":"2018","unstructured":"Ozer OF, Guler EM, Kocyigit A, et al. Raftlin, presepsin levels and thiol-disulphide homeostasis in acute appendicitis: a pilot study. J Pak Med Assoc. 2018;68(11):1660-1665.","journal-title":"J Pak Med Assoc"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261434243","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261434243","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261434243","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T06:59:21Z","timestamp":1782370761000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261434243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,7]]},"references-count":17,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/00031348261434243"],"URL":"https:\/\/doi.org\/10.1177\/00031348261434243","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,7]]}}}