{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T09:44:11Z","timestamp":1771235051056,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Introduction: Acute appendicitis (AA) is a common cause of abdominal pain that can lead to complications like perforation and intra-abdominal abscesses, increasing morbidity and mortality, often requiring emergency surgery. Nevertheless, appendectomy is performed in up to 95% of uncomplicated cases, while complications like perforation and intra-abdominal abscesses increase morbidity and mortality. The current study compares the accuracy of GPT-4.5, DeepSeek R1, and machine learning in assisting with surgical decision-making for patients presenting with lower abdominal pain at the Emergency Department. Methods: In this multicenter retrospective study, 63 histopathologically confirmed appendicitis patients and 50 control patients with right abdominal pain presenting at the Emergency Department at two German hospitals between October 2022 and October 2023 were included. Using each patient\u2019s clinical, laboratory, and radiological findings, DeepSeek (with and without Retrieval-Augmented Generation using 2020 Jerusalem guidelines) was compared in terms of accuracy with GPT-4.5 and a random forest-based machine-learning model, with a board-certified surgeon (reference standard) to determine the optimal treatment approach (laparoscopic exploration\/appendectomy versus conservative antibiotic therapy). Results: Accuracy of agreement with board-certified surgeons in the decision-making of appendectomy versus conservative therapy increased non-significantly from 80.5% to 83.2% with DeepSeek and from 70.8 to 76.1% when GPT-4.5 was provided with the World Journal of Emergency Surgery 2020 Jerusalem guidelines on the diagnosis and treatment of acute appendicitis. The estimated machine-learning model training accuracy was 84.3%, while the validation accuracy for the model was 85.0%. Discussion: GPT-4.5 and DeepSeek R1, as well as the machine-learning model, demonstrate promise in aiding surgical decision-making for appendicitis, particularly in resource-constrained settings. Ongoing training and validation are required to optimize the performance of such models.<\/jats:p>","DOI":"10.3390\/life15091387","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T13:27:44Z","timestamp":1756733264000},"page":"1387","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["From Bedside to Bot-Side: Artificial Intelligence in Emergency Appendicitis Management"],"prefix":"10.3390","volume":"15","author":[{"given":"Koray","family":"Ersahin","sequence":"first","affiliation":[{"name":"Department of General and Visceral Surgery, GFO Clinics Troisdorf, Academic Hospital of the Friedrich-Wilhelms-University Bonn, 50937 Troisdorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5961-9807","authenticated-orcid":false,"given":"Sebastian","family":"Sanduleanu","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology, GFO Clinics Troisdorf, Academic Hospital of the Friedrich-Wilhelms-University Bonn, 53840 Troisdorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9079-9949","authenticated-orcid":false,"given":"Sithin","family":"Thulasi Seetha","sequence":"additional","affiliation":[{"name":"National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6081-1070","authenticated-orcid":false,"given":"Johannes","family":"Bremm","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8982-0164","authenticated-orcid":false,"given":"Cavid","family":"Abbasli","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Engineering, Azerbaijan Technical University, AZ1073 Baku, Azerbaijan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chantal","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Cologne, 50391 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Damer","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, GFO Clinics Troisdorf, Academic Hospital of the Friedrich-Wilhelms-University Bonn, 50937 Troisdorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5021-6895","authenticated-orcid":false,"given":"Jonathan","family":"Kottlors","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Goertz","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6590-8181","authenticated-orcid":false,"given":"Christiane","family":"Bruns","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Tumor and Transplantation Surgery, University Hospital of Cologne, Kerpener Stra\u00dfe 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Maintz","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4522-537X","authenticated-orcid":false,"given":"Nuran","family":"Abdullayev","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology, GFO Clinics Troisdorf, Academic Hospital of the Friedrich-Wilhelms-University Bonn, 53840 Troisdorf, Germany"},{"name":"Institute for Biomedical Engineering, Azerbaijan Technical University, AZ1073 Baku, Azerbaijan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1001\/jamasurg.2018.4282","article-title":"Nonoperative Management of Uncomplicated Appendicitis Among Privately Insured Patients","volume":"154","author":"Sceats","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1056\/NEJMc2116018","article-title":"Antibiotics versus Appendectomy for Acute Appendicitis\u2014Longer-Term Outcomes","volume":"385","author":"Davidson","year":"2021","journal-title":"N. 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