{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:25:01Z","timestamp":1793121901837,"version":"4.5.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T00:00:00Z","timestamp":1659484800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Some studies have shown poor agreement between intraoperative and histopathological classifications for appendicitis, despite their routine use in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the agreement between histopathological and intraoperative classifications for pediatric appendicitis and evaluate the predictive potential of these classifications for the post-operative outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective, longitudinal, observational single-center study, carried out with 485 patients up to15 years of age, with a confirmed diagnosis of acute appendicitis by histopathological evaluation. The histopathological results classified the appendices as uncomplicated appendicitis when there was confirmation of the diagnosis of appendicitis without necrosis or perforation and complicated appendicitis when there was extensive necrotic tissue in the outer layer of the appendix or signs of perforation. The intraoperative findings were classified as uncomplicated appendicitis when the appendix presented with hyperemia and edema or fibrinous exudate and complicated appendicitis when the appendix showed necrosis, abscess, or perforation. The kappa index determined the agreement and the prediction relationships using a generalized linear model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>43.9% of cases were classified as complicated appendicitis by histopathological evaluation and 49.7% by intraoperative classification. The agreement analysis between the histopathological and intraoperative classification showed a moderate agreement, with a Kappa index of 0.419 (0.337\u20130.501). There was an association (<jats:italic>P<\/jats:italic> &amp;lt; 0.05) between the intraoperative classification and the post-operative clinical outcomes (time to start feeding, fever, intraabdominal collection, length of stay, the need for antibiotic therapy changing, and need for ICU). There was no association between histopathological classification and post-operative outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The agreement between the two classifications was moderate, and the intraoperative classification was able to predict the post-operative clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2022.908226","type":"journal-article","created":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T05:04:10Z","timestamp":1659503050000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome"],"prefix":"10.3389","volume":"10","author":[{"given":"Camila de Paula","family":"Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika Veruska Paiva","family":"Ortolan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Marrone","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna Aliotto Nalin","family":"Tedesco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone Antunes","family":"Terra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Aparecida Marchesan","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Luiz Toledo de Arruda","family":"Louren\u00e7\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1398","DOI":"10.1016\/j.jpedsurg.2010.02.048","article-title":"Discordance of the pediatric surgeon's intraoperative assessment of pediatric appendicitis with the pathologists report","volume":"45","author":"Bliss","year":"2010","journal-title":"J Pediatr Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1089\/sur.2013.155","article-title":"Correlation between intraoperative surgical diagnosis of complicated acute appendicitis and the pathology report: clinical implications","volume":"16","author":"Correa","year":"2015","journal-title":"Surg Infect."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2088","DOI":"10.1007\/s11605-019-04345-3","article-title":"Discrepancies between intraoperative and histological evaluation of the appendix in acute appendicitis","volume":"24","author":"Bolmers","year":"2020","journal-title":"J Gastrointest Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/j.jss.2015.08.042","article-title":"A scoring system to predict the severity of appendicitis in children","volume":"200","author":"Gorter","year":"2016","journal-title":"J Surg Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.yasu.2021.05.002","article-title":"Advances in the diagnosis and management of appendicitis in children","volume":"55","author":"He","year":"2021","journal-title":"Adv Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1097\/SLA.0000000000003059","article-title":"Development and implications of an evidence-based and public health-relevant definition of complicated appendicitis in children","volume":"271","author":"Cameron","year":"2020","journal-title":"Ann Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"S15","DOI":"10.1089\/lap.2008.0095.supp","article-title":"Interobserver variation in the assessment of appendiceal perforation","volume":"1","author":"Ponsky","year":"2009","journal-title":"J Laparoendosc Adv Surg Tech A."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1002\/bjs.10837","article-title":"Interobserver variability in the classification of appendicitis during laparoscopy","volume":"105","author":"van den Boom","year":"2018","journal-title":"Br J Surg."},{"key":"B9","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1159\/isbn.978-3-318-00270-6","volume-title":"Acute Appendicitis: Standard Treatment or Laparoscopic Surgery?","author":"Krahenbuhl","year":"1998"},{"key":"B10","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/S1092-9134(00)90011-X","article-title":"The pathology of acute appendicitis","volume":"4","author":"Carr","year":"2000","journal-title":"Ann Diagn Pathol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.ijsu.2015.01.032","article-title":"How good are surgeons at identifying appendicitis? Results from a multi-centre cohort study","volume":"15","author":"Strong","year":"2015","journal-title":"Int J Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"342","DOI":"10.7196\/SAMJ.2017.v108i4.12759","article-title":"The usefulness of routine histological examination of appendicectomy specimens in a South African tertiary centre","volume":"108","author":"Jolayemi","year":"2018","journal-title":"S Afr Med J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1136\/jcp.45.5.456","article-title":"Histological audit of acute appendicitis","volume":"45","author":"Herd","year":"1992","journal-title":"J Clin Pathol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1016\/j.jpedsurg.2014.11.001","article-title":"Correlating surgical and pathological diagnoses in pediatric appendicitis","volume":"50","author":"Fallon","year":"2015","journal-title":"J Pediatr Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.1016\/j.jpedsurg.2019.09.025","article-title":"Evaluation of concordance among surgeons and pathologists regarding the diagnosis and classification of acute appendicitis in children","volume":"55","author":"Rodr\u00edguez","year":"2020","journal-title":"J Pediatr Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1016\/j.jpedsurg.2015.02.064","article-title":"Operative findings are a better predictor of resource utilization in pediatric appendicitis","volume":"50","author":"Farach","year":"2015","journal-title":"J Pediatr Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics."},{"key":"B18","first-page":"593","article-title":"A comparison of surgical impression, histological findings, and microbiological results at open appendectomy","volume":"100","author":"Colleran","year":"2007","journal-title":"Ir Med J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s13017-015-0053-2","article-title":"Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings","volume":"10","author":"Gomes","year":"2015","journal-title":"World J Emerg Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1111\/j.1463-1318.2010.02457.x","article-title":"Is routine histopathological examination of appendectomy specimens useful? A systematic review of the literature","volume":"13","author":"Swank","year":"2011","journal-title":"Colorectal Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.surg.2020.03.032","article-title":"Routine histopathologic examination of the appendix after appendectomy for presumed appendicitis: is it really necessary? A systematic review and meta-analysis","volume":"168","author":"Bastiaenen","year":"2020","journal-title":"Surgery."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1007\/s00383-011-2926-0","article-title":"Routine histopathological examination of appendectomy specimens in children: is there any rationale?","volume":"27","author":"Khan","year":"2011","journal-title":"Pediatr Surg Int."},{"key":"B23","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1007\/s12262-013-0934-0","article-title":"Unusual histopathological findings in childhood appendectomy specimens","volume":"77","author":"Buyukbese Sarsu","year":"2015","journal-title":"Indian J Surg."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005228","article-title":"Oncological safety and potential cost savings of routine versus selective histopathological examination following appendectomy: results of the multicenter, prospective, cross-sectional FANCY study","author":"Bastiaenen","year":"2021","journal-title":"Ann Surg"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.908226\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T05:04:13Z","timestamp":1659503053000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.908226\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,3]]},"references-count":24,"alternative-id":["10.3389\/fped.2022.908226"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.908226","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,3]]},"article-number":"908226"}}