{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:13:10Z","timestamp":1782922390580,"version":"3.54.5"},"reference-count":121,"publisher":"Springer Science and Business Media LLC","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,31]]},"DOI":"10.7759\/cureus.81516","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T16:55:37Z","timestamp":1743440137000},"source":"Crossref","is-referenced-by-count":2,"title":["Balancing Between Negative Appendectomy and Complicated Appendicitis: A Persisting Reality Under the Rule of the Uncertainty Principle"],"prefix":"10.7759","author":[{"given":"Stylianos","family":"Roupakias","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Kambouri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelos","family":"Al Nimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Bekiaridou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Blevrakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Tsalikidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xenophon","family":"Sinopidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcw193","article-title":"Heisenberg's uncertainty principle","volume":"110","author":"Eastwood MA","year":"2017","unstructured":"Eastwood MA. Heisenberg's uncertainty principle. QJM. 2017, 110:335-6. 10.1093\/qjmed\/hcw193","journal-title":"QJM"},{"key":"ref2","article-title":"Understanding medical uncertainty: a primer for physicians","volume":"52","author":"Ghosh AK","year":"2004","unstructured":"Ghosh AK. Understanding medical uncertainty: a primer for physicians. J Assoc Physicians India. 2004, 52:739-42.","journal-title":"J Assoc Physicians India"},{"key":"ref3","doi-asserted-by":"crossref","DOI":"10.1111\/j.1572-0241.2001.05321.x","article-title":"A medical uncertainty principle","volume":"96","author":"Sonnenberg A","year":"2001","unstructured":"Sonnenberg A. A medical uncertainty principle. Am J Gastroenterol. 2001, 96:3247-50.","journal-title":"Am J Gastroenterol"},{"key":"ref4","article-title":"The evolution of medical uncertainty","volume":"58","author":"Fox RC","year":"1980","unstructured":"Fox RC. The evolution of medical uncertainty. Milbank Mem Fund Q Health Soc. 1980, 58:1-49.","journal-title":"Milbank Mem Fund Q Health Soc"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3946\/kjme.2018.92","article-title":"Understanding uncertainty in medicine: concepts and implications in medical education","volume":"30","author":"Kim K","year":"2018","unstructured":"Kim K, Lee YM. Understanding uncertainty in medicine: concepts and implications in medical education. Korean J Med Educ. 2018, 30:181-8. 10.3946\/kjme.2018.92","journal-title":"Korean J Med Educ"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-017-4164-1","article-title":"Defining and measuring diagnostic uncertainty in medicine: a systematic review","volume":"33","author":"Bhise V","year":"2018","unstructured":"Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H. Defining and measuring diagnostic uncertainty in medicine: a systematic review. J Gen Intern Med. 2018, 33:103-15. 10.1007\/s11606-017-4164-1","journal-title":"J Gen Intern Med"},{"key":"ref7","article-title":"Acute appendicitis in children: how is it different than in adults?","volume":"1","author":"Dahal GR","year":"2019","unstructured":"Dahal GR. Acute appendicitis in children: how is it different than in adults?. GMJ. 2019, 1:35-40.","journal-title":"GMJ"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2012.10.003","article-title":"Appendicitis in children less than 5 years old: influence of age on presentation and outcome","volume":"204","author":"Bansal S","year":"2012","unstructured":"Bansal S, Banever GT, Karrer FM, Partrick DA. Appendicitis in children less than 5 years old: influence of age on presentation and outcome. Am J Surg. 2012, 204:1031-5. 10.1016\/j.amjsurg.2012.10.003","journal-title":"Am J Surg"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2008.06.003","article-title":"Appendicitis in pre-school children: a continuing clinical challenge. A retrospective study","volume":"6","author":"Mallick MS","year":"2008","unstructured":"Mallick MS. Appendicitis in pre-school children: a continuing clinical challenge. A retrospective study. Int J Surg. 2008, 6:371-3. 10.1016\/j.ijsu.2008.06.003","journal-title":"Int J Surg"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-002-0898-9","article-title":"Appendicitis in infancy","volume":"19","author":"Lin YL","year":"2003","unstructured":"Lin YL, Lee C. Appendicitis in infancy. Pediatr Surg Int. 2003, 19:1-3. 10.1007\/s00383-002-0898-9","journal-title":"Pediatr Surg Int"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-002-0775-6","article-title":"Appendicitis in children less than 3 years of age: a 28-year review","volume":"19","author":"Alloo J","year":"2004","unstructured":"Alloo J, Gerstle T, Shilyansky J, Ein SH. Appendicitis in children less than 3 years of age: a 28-year review. Pediatr Surg Int. 2004, 19:777-9. 10.1007\/s00383-002-0775-6","journal-title":"Pediatr Surg Int"},{"key":"ref12","article-title":"Misdiagnosed acute appendicitis in children in the emergency department","volume":"33","author":"Chang YJ","year":"2010","unstructured":"Chang YJ, Chao HC, Kong MS, Hsia SH, Yan DC. Misdiagnosed acute appendicitis in children in the emergency department. Chang Gung Med J. 2010, 33:551-7.","journal-title":"Chang Gung Med J"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2017.0053","article-title":"The threat of diagnostic uncertainty in the medical management of uncomplicated appendicitis","volume":"171","author":"Bachur RG","year":"2017","unstructured":"Bachur RG, Rangel SJ. The threat of diagnostic uncertainty in the medical management of uncomplicated appendicitis. JAMA Pediatr. 2017, 171:505-6. 10.1001\/jamapediatrics.2017.0053","journal-title":"JAMA Pediatr"},{"key":"ref14","article-title":"Application of Heisenberg's uncertainty principle in children with appendicitis: false-negative x false-positive errors","volume":"41","author":"Roupakias S","year":"2024","unstructured":"Roupakias S. Application of Heisenberg's uncertainty principle in children with appendicitis: false-negative x false-positive errors. Arch Hell Med. 2024, 41:275-278.","journal-title":"Arch Hell Med"},{"key":"ref15","article-title":"Delays by patients, emergency physicians, and surgeons in the management of acute appendicitis: retrospective study","volume":"6","author":"Chung CH","year":"2000","unstructured":"Chung CH, Ng CP, Lai KK. Delays by patients, emergency physicians, and surgeons in the management of acute appendicitis: retrospective study. Hong Kong Med J. 2000, 6:254-9.","journal-title":"Hong Kong Med J"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.14712\/23362936.2021.4","article-title":"Acute appendicitis in a diabetic child with Salmonella infection","volume":"122","author":"Roupakias S","year":"2021","unstructured":"Roupakias S, Apostolou MI, Anastasiou A. Acute appendicitis in a diabetic child with Salmonella infection. Prague Med Rep. 2021, 122:34-8. 10.14712\/23362936.2021.4","journal-title":"Prague Med Rep"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.4103\/0189-6725.132796","article-title":"Complicated appendicitis: analysis of risk factors in children","volume":"11","author":"Singh M","year":"2014","unstructured":"Singh M, Kadian YS, Rattan KN, Jangra B. Complicated appendicitis: analysis of risk factors in children. Afr J Paediatr Surg. 2014, 11:109-13. 10.4103\/0189-6725.132796","journal-title":"Afr J Paediatr Surg"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.2020.0764","article-title":"Acute appendicitis in childhood and adulthood","volume":"117","author":"T\u00e9oule P","year":"2020","unstructured":"T\u00e9oule P, de Laffolie J, Rolle U, Reissfelder C. Acute appendicitis in childhood and adulthood. Dtsch Arztebl Int. 2020, 117:764-74. 10.3238\/arztebl.2020.0764","journal-title":"Dtsch Arztebl Int"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2000.tb00470.x","article-title":"False-negative and false-positive errors in abdominal pain evaluation: failure to diagnose acute appendicitis and unnecessary surgery","volume":"7","author":"Graff L","year":"2000","unstructured":"Graff L, Russell J, Seashore J, et al.. False-negative and false-positive errors in abdominal pain evaluation: failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med. 2000, 7:1244-55. 10.1111\/j.1553-2712.2000.tb00470.x","journal-title":"Acad Emerg Med"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000874","article-title":"Disease severity, not operative approach, drives organ space infection after pediatric appendectomy","volume":"260","author":"Kelly KN","year":"2014","unstructured":"Kelly KN, Fleming FJ, Aquina CT, Probst CP, Noyes K, Pegoli W, Monson JR. Disease severity, not operative approach, drives organ space infection after pediatric appendectomy. Ann Surg. 2014, 260:466-73. 10.1097\/SLA.0000000000000874","journal-title":"Ann Surg"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.54847\/cp.2022.02.14","article-title":"Re-interventions following appendectomy in children: a multicenter study","volume":"35","author":"Blanco Verd\u00fa MD","year":"2022","unstructured":"Blanco Verd\u00fa MD, Pel\u00e1ez Mata DJ, G\u00f3mez S\u00e1nchez A, et al.. Re-interventions following appendectomy in children: a multicenter study. Cir Pediatr. 2022, 35:70-4. 10.54847\/cp.2022.02.14","journal-title":"Cir Pediatr"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v12.i4.129","article-title":"Management of complicated acute appendicitis in children: still an existing controversy","volume":"12","author":"Zavras N","year":"2020","unstructured":"Zavras N, Vaos G. Management of complicated acute appendicitis in children: still an existing controversy. World J Gastrointest Surg. 2020, 12:129-37. 10.4240\/wjgs.v12.i4.129","journal-title":"World J Gastrointest Surg"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.2147\/PHMT.S155302","article-title":"Perforation risk in pediatric appendicitis: assessment and management","volume":"9","author":"Howell EC","year":"2018","unstructured":"Howell EC, Dubina ED, Lee SL. Perforation risk in pediatric appendicitis: assessment and management. Pediatric Health Med Ther. 2018, 9:135-45. 10.2147\/PHMT.S155302","journal-title":"Pediatric Health Med Ther"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2019.03.013","article-title":"Population-based cohort study of the correlation between provision of care and the risk for complications after appendectomy in children","volume":"54","author":"Almstr\u00f6m M","year":"2019","unstructured":"Almstr\u00f6m M, Svensson JF, Svenningsson A, Hagel E, Wester T. Population-based cohort study of the correlation between provision of care and the risk for complications after appendectomy in children. J Pediatr Surg. 2019, 54:2279-84. 10.1016\/j.jpedsurg.2019.03.013","journal-title":"J Pediatr Surg"},{"key":"ref25","article-title":"Acute appendicitis in children: clinical manifestations and diagnosis","author":"Brandt ML","year":"2025","unstructured":"Brandt ML, Lopez ME. Acute appendicitis in children: clinical manifestations and diagnosis. UpToDate. Post TW (ed): Waltham, MA; 2025."},{"key":"ref26","doi-asserted-by":"crossref","DOI":"10.1542\/peds.76.2.301","article-title":"Childhood appendicitis: factors associated with perforation","volume":"76","author":"Brender JD","year":"1985","unstructured":"Brender JD, Marcuse EK, Koepsell TD, Hatch EI. Childhood appendicitis: factors associated with perforation. Pediatrics. 1985, 76:301-6.","journal-title":"Pediatrics"},{"key":"ref27","article-title":"The continuing challenge of perforating appendicitis","volume":"150","author":"Scher KS","year":"1980","unstructured":"Scher KS, Coil JA. The continuing challenge of perforating appendicitis. Surg Gynecol Obstet. 1980, 150:535-8.","journal-title":"Surg Gynecol Obstet"},{"key":"ref28","doi-asserted-by":"crossref","DOI":"10.1016\/S0002-9610(96)00011-6","article-title":"Delay of surgery in acute appendicitis","volume":"173","author":"Eldar S","year":"1997","unstructured":"Eldar S, Nash E, Sabo E, Matter I, Kunin J, Mogilner JG, Abrahamson J. Delay of surgery in acute appendicitis. Am J Surg. 1997, 173:194-198.","journal-title":"Am J Surg"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1975.01360110223039","article-title":"Appendicitis. A critical review of diagnosis and treatment in 1,000 cases","volume":"110","author":"Lewis FR","year":"1975","unstructured":"Lewis FR, Holcroft JW, Boey J, Dunphy JE. Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg. 1975, 110:677-84. 10.1001\/archsurg.1975.01360110223039","journal-title":"Arch Surg"},{"key":"ref30","article-title":"Current features in the treatment of acute appendicitis: an analysis of 1,000 consecutive cases","volume":"60","author":"Mittelpunkt A","year":"1966","unstructured":"Mittelpunkt A, Nora PF. Current features in the treatment of acute appendicitis: an analysis of 1,000 consecutive cases. Surgery. 1966, 60:971-5.","journal-title":"Surgery"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38940.664363.AE","article-title":"Acute appendicitis","volume":"333","author":"Humes DJ","year":"2006","unstructured":"Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006, 333:530. 10.1136\/bmj.38940.664363.AE","journal-title":"BMJ"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318265ea13","article-title":"Appendectomy timing: waiting until the next morning increases the risk of surgical site infections","volume":"256","author":"Teixeira PG","year":"2012","unstructured":"Teixeira PG, Sivrikoz E, Inaba K, Talving P, Lam L, Demetriades D. Appendectomy timing: waiting until the next morning increases the risk of surgical site infections. Ann Surg. 2012, 256:538-43. 10.1097\/SLA.0b013e318265ea13","journal-title":"Ann Surg"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2018.10.106","article-title":"The impact of pathological criteria on pediatric negative appendectomy rate","volume":"54","author":"Maloney C","year":"2019","unstructured":"Maloney C, Edelman MC, Bolognese AC, Lipskar AM, Rich BS. The impact of pathological criteria on pediatric negative appendectomy rate. J Pediatr Surg. 2019, 54:1794-9. 10.1016\/j.jpedsurg.2018.10.106","journal-title":"J Pediatr Surg"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2011.04.046","article-title":"Pediatric negative appendectomy rate: trend, predictors, and differentials","volume":"173","author":"Oyetunji TA","year":"2012","unstructured":"Oyetunji TA, Ong'uti SK, Bolorunduro OB, Cornwell EE III, Nwomeh BC. Pediatric negative appendectomy rate: trend, predictors, and differentials. J Surg Res. 2012, 173:16-20. 10.1016\/j.jss.2011.04.046","journal-title":"J Surg Res"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-014-3009-x","article-title":"Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases","volume":"44","author":"Kim SH","year":"2014","unstructured":"Kim SH, Choi YH, Kim WS, Cheon JE, Kim IO. Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases. Pediatr Radiol. 2014, 44:1243-51. 10.1007\/s00247-014-3009-x","journal-title":"Pediatr Radiol"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2017.07.075","article-title":"Predictive factors of negative appendectomy in children","volume":"36","author":"Zouari M","year":"2018","unstructured":"Zouari M, Abid I, Ben Dhaou M, Louati H, Jallouli M, Mhiri R. Predictive factors of negative appendectomy in children. Am J Emerg Med. 2018, 36:335-6. 10.1016\/j.ajem.2017.07.075","journal-title":"Am J Emerg Med"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-1665","article-title":"Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis","volume":"131","author":"Saito JM","year":"2013","unstructured":"Saito JM, Yan Y, Evashwick TW, Warner BW, Tarr PI. Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis. Pediatrics. 2013, 131:e37-44. 10.1542\/peds.2012-1665","journal-title":"Pediatrics"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2004.02.034","article-title":"CT scans may not reduce the negative appendectomy rate in children","volume":"39","author":"Martin AE","year":"2004","unstructured":"Martin AE, Vollman D, Adler B, Caniano DA. CT scans may not reduce the negative appendectomy rate in children. J Pediatr Surg. 2004, 39:886-90. 10.1016\/j.jpedsurg.2004.02.034","journal-title":"J Pediatr Surg"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-2418","article-title":"Use of white blood cell count and negative appendectomy rate","volume":"133","author":"Bates MF","year":"2014","unstructured":"Bates MF, Khander A, Steigman SA, Tracy TF Jr, Luks FI. Use of white blood cell count and negative appendectomy rate. Pediatrics. 2014, 133:e39-44. 10.1542\/peds.2013-2418","journal-title":"Pediatrics"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2003.50111","article-title":"Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals","volume":"38","author":"Newman K","year":"2003","unstructured":"Newman K, Ponsky T, Kittle K, et al.. Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg. 2003, 38:372-9. 10.1053\/jpsu.2003.50111","journal-title":"J Pediatr Surg"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2017.06.063","article-title":"Clinical and socioeconomic factors associated with negative pediatric appendicitis","volume":"218","author":"Dubrovsky G","year":"2017","unstructured":"Dubrovsky G, Rouch J, Huynh N, Friedlander S, Lu Y, Lee SL. Clinical and socioeconomic factors associated with negative pediatric appendicitis. J Surg Res. 2017, 218:322-8. 10.1016\/j.jss.2017.06.063","journal-title":"J Surg Res"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2016.11.045","article-title":"Improving ultrasound for appendicitis through standardized reporting of secondary signs","volume":"52","author":"Partain KN","year":"2017","unstructured":"Partain KN, Patel AU, Travers C, et al.. Improving ultrasound for appendicitis through standardized reporting of secondary signs. J Pediatr Surg. 2017, 52:1273-9. 10.1016\/j.jpedsurg.2016.11.045","journal-title":"J Pediatr Surg"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.25825","article-title":"Performance of MRI for suspected appendicitis in pediatric patients and negative appendectomy rate: a systematic review and meta-analysis","volume":"47","author":"Kim JR","year":"2018","unstructured":"Kim JR, Suh CH, Yoon HM, et al.. Performance of MRI for suspected appendicitis in pediatric patients and negative appendectomy rate: a systematic review and meta-analysis. J Magn Reson Imaging. 2018, 47:767-78. 10.1002\/jmri.25825","journal-title":"J Magn Reson Imaging"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.2517","article-title":"Outcomes of pediatric appendicitis: an international comparison of the United States and Canada","volume":"149","author":"Cheong LH","year":"2014","unstructured":"Cheong LH, Emil S. Outcomes of pediatric appendicitis: an international comparison of the United States and Canada. JAMA Surg. 2014, 149:50-5. 10.1001\/jamasurg.2013.2517","journal-title":"JAMA Surg"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-3375","article-title":"Diagnostic imaging and negative appendectomy rates in children: effects of age and gender","volume":"129","author":"Bachur RG","year":"2012","unstructured":"Bachur RG, Hennelly K, Callahan MJ, Chen C, Monuteaux MC. Diagnostic imaging and negative appendectomy rates in children: effects of age and gender. Pediatrics. 2012, 129:877-84. 10.1542\/peds.2011-3375","journal-title":"Pediatrics"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9201","article-title":"Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy","volume":"100","year":"2013","unstructured":"Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy. Br J Surg. 2013, 100.1240-52. 10.1002\/bjs.9201","journal-title":"Br J Surg"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1016\/j.smim.2018.02.005","article-title":"The immunological functions of the appendix: an example of redundancy?","volume":"36","author":"Girard-Madoux MJ","year":"2018","unstructured":"Girard-Madoux MJ, de Ag\u00fcero MG, Ganal-Vonarburg SC, Mooser C, Belz GT, Macpherson AJ, Vivier E. The immunological functions of the appendix: an example of redundancy?. Semin Immunol. 2018, 36:31-44. 10.1016\/j.smim.2018.02.005","journal-title":"Semin Immunol"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1111\/cei.12821","article-title":"The immunology of the vermiform appendix: a review of the literature","volume":"186","author":"Kooij IA","year":"2016","unstructured":"Kooij IA, Sahami S, Meijer SL, Buskens CJ, Te Velde AA. The immunology of the vermiform appendix: a review of the literature. Clin Exp Immunol. 2016, 186:1-9. 10.1111\/cei.12821","journal-title":"Clin Exp Immunol"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms8040609","article-title":"Incidental prophylactic appendectomy is associated with a profound microbial dysbiosis in the long-term","volume":"8","author":"S\u00e1nchez-Alcoholado L","year":"2020","unstructured":"S\u00e1nchez-Alcoholado L, Fern\u00e1ndez-Garc\u00eda JC, Guti\u00e9rrez-Repiso C, et al.. Incidental prophylactic appendectomy is associated with a profound microbial dysbiosis in the long-term. Microorganisms. 2020, 8:609. 10.3390\/microorganisms8040609","journal-title":"Microorganisms"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.724980","article-title":"Appendectomy is associated with alteration of human gut bacterial and fungal communities","volume":"12","author":"Cai S","year":"2021","unstructured":"Cai S, Fan Y, Zhang B, et al.. Appendectomy is associated with alteration of human gut bacterial and fungal communities. Front Microbiol. 2021, 12:724980. 10.3389\/fmicb.2021.724980","journal-title":"Front Microbiol"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2020.422","article-title":"Impact of appendectomy on gut microbiota","volume":"22","author":"Babakhanov AT","year":"2021","unstructured":"Babakhanov AT, Dzhumabekov AT, Zhao AV, et al.. Impact of appendectomy on gut microbiota. Surg Infect (Larchmt). 2021, 22:651-61. 10.1089\/sur.2020.422","journal-title":"Surg Infect (Larchmt)"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfda.2018.12.012","article-title":"Revisit gut microbiota and its impact on human health and disease","volume":"27","author":"Ding RX","year":"2019","unstructured":"Ding RX, Goh WR, Wu RN, et al.. Revisit gut microbiota and its impact on human health and disease. J Food Drug Anal. 2019, 27:623-31. 10.1016\/j.jfda.2018.12.012","journal-title":"J Food Drug Anal"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198411000-00002","article-title":"Appendicitis near its centenary","volume":"200","author":"Berry J Jr","year":"1984","unstructured":"Berry J Jr, Malt RA. Appendicitis near its centenary. Ann Surg. 1984, 200:567-75. 10.1097\/00000658-198411000-00002","journal-title":"Ann Surg"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12144","article-title":"The implications of missed opportunities to diagnose appendicitis in children","volume":"20","author":"Naiditch JA","year":"2013","unstructured":"Naiditch JA, Lautz TB, Daley S, Pierce MC, Reynolds M. The implications of missed opportunities to diagnose appendicitis in children. Acad Emerg Med. 2013, 20:592-6. 10.1111\/acem.12144","journal-title":"Acad Emerg Med"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1570757","article-title":"Misdiagnosis of acute appendicitis in children attending the emergency department: the experience of a large, tertiary care pediatric hospital","volume":"27","author":"Galai T","year":"2017","unstructured":"Galai T, Beloosesky OZ, Scolnik D, Rimon A, Glatstein M. Misdiagnosis of acute appendicitis in children attending the emergency department: the experience of a large, tertiary care pediatric hospital. Eur J Pediatr Surg. 2017, 27:138-41. 10.1055\/s-0035-1570757","journal-title":"Eur J Pediatr Surg"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.0612","article-title":"Factors associated with potentially missed diagnosis of appendicitis in the emergency department","volume":"3","author":"Mahajan P","year":"2020","unstructured":"Mahajan P, Basu T, Pai CW, et al.. Factors associated with potentially missed diagnosis of appendicitis in the emergency department. JAMA Netw Open. 2020, 3:e200612. 10.1001\/jamanetworkopen.2020.0612","journal-title":"JAMA Netw Open"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1080\/08941939.2018.1453566","article-title":"Negative appendectomy. It is really preventable?","volume":"32","author":"Ambe PC","year":"2018","unstructured":"Ambe PC. Negative appendectomy. It is really preventable?. J Invest Surg. 2018, 32:474-5. 10.1080\/08941939.2018.1453566","journal-title":"J Invest Surg"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1080\/21548331.1987.11707687","article-title":"Tolerating uncertainty","volume":"22","author":"Kassirer JP","year":"1987","unstructured":"Kassirer JP, Kopelman RI. Tolerating uncertainty. Hosp Pract (Off Ed). 1987, 22:21-8. 10.1080\/21548331.1987.11707687","journal-title":"Hosp Pract (Off Ed)"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1590\/0102-6720201700010014","article-title":"Modified Alvarado score in children with diagnosis of appendicitis","volume":"30","author":"Peyvasteh M","year":"2017","unstructured":"Peyvasteh M, Askarpour S, Javaherizadeh H, Besharati S. Modified Alvarado score in children with diagnosis of appendicitis. Arq Bras Cir Dig. 2017, 30:51-2. 10.1590\/0102-6720201700010014","journal-title":"Arq Bras Cir Dig"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3182586d34","article-title":"Application of pediatric appendicitis score on the emergency department of a secondary level hospital","volume":"28","author":"Z\u00fa\u00f1iga RV","year":"2012","unstructured":"Z\u00fa\u00f1iga RV, Arribas JL, Montes SP, Fernandez MN, Abad CG, Martin LG, Gonz\u00e1lez-Sagrado M. Application of pediatric appendicitis score on the emergency department of a secondary level hospital. Pediatr Emerg Care. 2012, 28:489-92. 10.1097\/PEC.0b013e3182586d34","journal-title":"Pediatr Emerg Care"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000000375","article-title":"Prospective validation of Alvarado score and pediatric appendicitis score for the diagnosis of acute appendicitis in children","volume":"31","author":"Pogoreli\u0107 Z","year":"2015","unstructured":"Pogoreli\u0107 Z, Rak S, Mrkli\u0107 I, Juri\u0107 I. Prospective validation of Alvarado score and pediatric appendicitis score for the diagnosis of acute appendicitis in children. Pediatr Emerg Care. 2015, 31:164-8. 10.1097\/PEC.0000000000000375","journal-title":"Pediatr Emerg Care"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.131820","article-title":"Masterly inactivity: a forgotten precept","volume":"186","author":"Mai F","year":"2014","unstructured":"Mai F. Masterly inactivity: a forgotten precept. CMAJ. 2014, 186:312. 10.1503\/cmaj.131820","journal-title":"CMAJ"},{"key":"ref63","article-title":"Intensive in-hospital observation: a safe way to decrease unnecessary appendectomy","volume":"41","author":"White JJ","year":"1975","unstructured":"White JJ, Santillana M, Haller JA Jr. Intensive in-hospital observation: a safe way to decrease unnecessary appendectomy. Am Surg. 1975, 41:793-8.","journal-title":"Am Surg"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.o2305","article-title":"When I use a word . . . . too much healthcare-uncertainty, underconfidence, and masterly inactivity","volume":"378","author":"Aronson JK","year":"2022","unstructured":"Aronson JK. When I use a word . . . . too much healthcare-uncertainty, underconfidence, and masterly inactivity. BMJ. 2022, 378:o2305. 10.1136\/bmj.o2305","journal-title":"BMJ"},{"key":"ref65","article-title":"Clinical Reasoning in the Health Professions, 2nd Ed","author":"Higgs J","year":"2002","unstructured":"Higgs J, Jones M. Clinical Reasoning in the Health Professions, 2nd Ed. Butterworth\u2010Heinemann, Oxford, UK; 2002."},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13181","article-title":"Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis","volume":"24","author":"Benabbas R","year":"2017","unstructured":"Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2017, 24:523-51. 10.1111\/acem.13181","journal-title":"Acad Emerg Med"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-008-1131-3","article-title":"Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A North American perspective","volume":"39","author":"Frush DP","year":"2009","unstructured":"Frush DP, Frush KS, Oldham KT. Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A North American perspective. Pediatr Radiol. 2009, 39:500-5. 10.1007\/s00247-008-1131-3","journal-title":"Pediatr Radiol"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-008-1130-4","article-title":"Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A European perspective","volume":"39","author":"Holscher HC","year":"2009","unstructured":"Holscher HC, Heij HA. Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A European perspective. Pediatr Radiol. 2009, 39:497-9. 10.1007\/s00247-008-1130-4","journal-title":"Pediatr Radiol"},{"key":"ref69","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2014.9.21568","article-title":"Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014","volume":"15","author":"Shogilev DJ","year":"2014","unstructured":"Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med. 2014, 15:859-71. 10.5811\/westjem.2014.9.21568","journal-title":"West J Emerg Med"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc0707000","article-title":"Effect of CT on false positive diagnosis of appendicitis and perforation","volume":"358","author":"Raman SS","year":"2008","unstructured":"Raman SS, Osuagwu FC, Kadell B, Cryer H, Sayre J, Lu DS. Effect of CT on false positive diagnosis of appendicitis and perforation. N Engl J Med. 2008, 358:972-3. 10.1056\/NEJMc0707000","journal-title":"N Engl J Med"},{"key":"ref71","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.023509","article-title":"Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis","volume":"54","author":"Krajewski S","year":"2011","unstructured":"Krajewski S, Brown J, Phang PT, Raval M, Brown CJ. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg. 2011, 54:43-53. 10.1503\/cjs.023509","journal-title":"Can J Surg"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2018.09.033","article-title":"ACR Appropriateness Criteria(\u00ae) right lower quadrant pain-suspected appendicitis","volume":"15","author":"Garcia EM","year":"2018","unstructured":"Garcia EM, Camacho MA, Karolyi DR, et al.. ACR Appropriateness Criteria(\u00ae) right lower quadrant pain-suspected appendicitis. J Am Coll Radiol. 2018, 15:S373-87. 10.1016\/j.jacr.2018.09.033","journal-title":"J Am Coll Radiol"},{"key":"ref73","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-008-1105-5","article-title":"Optimizing the role of imaging in appendicitis","volume":"39","author":"Doria AS","year":"2009","unstructured":"Doria AS. Optimizing the role of imaging in appendicitis. Pediatr Radiol. 2009, 39:S144-8. 10.1007\/s00247-008-1105-5","journal-title":"Pediatr Radiol"},{"key":"ref74","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.176.2.1760289","article-title":"Estimated risks of radiation-induced fatal cancer from pediatric CT","volume":"176","author":"Brenner DJ","year":"2001","unstructured":"Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001, 176:289-96. 10.2214\/ajr.176.2.1760289","journal-title":"AJR Am J Roentgenol"},{"key":"ref75","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.221303","article-title":"Risks of leukemia, intracranial tumours and lymphomas in childhood and early adulthood after pediatric radiation exposure from computed tomography","volume":"195","author":"Wang WH","year":"2023","unstructured":"Wang WH, Sung CY, Wang SC, Shao YH. Risks of leukemia, intracranial tumours and lymphomas in childhood and early adulthood after pediatric radiation exposure from computed tomography. CMAJ. 2023, 195:E575-83. 10.1503\/cmaj.221303","journal-title":"CMAJ"},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.176.1.1760031","article-title":"Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography","volume":"176","author":"Lowe LH","year":"2001","unstructured":"Lowe LH, Penney MW, Stein SM, Heller RM, Neblett WW, Shyr Y, Hernanz-Schulman M. Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography. AJR Am J Roentgenol. 2001, 176:31-5. 10.2214\/ajr.176.1.1760031","journal-title":"AJR Am J Roentgenol"},{"key":"ref77","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2018.05.014","article-title":"Diagnostic accuracy of surgeon performed ultrasound (SPU) for appendicitis in children","volume":"53","author":"Soundappan SS","year":"2018","unstructured":"Soundappan SS, Karpelowsky J, Lam A, Lam L, Cass D. Diagnostic accuracy of surgeon performed ultrasound (SPU) for appendicitis in children. J Pediatr Surg. 2018, 53:2023-7. 10.1016\/j.jpedsurg.2018.05.014","journal-title":"J Pediatr Surg"},{"key":"ref78","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e31828e5718","article-title":"Clinical practice guidelines for pediatric appendicitis evaluation can decrease computed tomography utilization while maintaining diagnostic accuracy","volume":"29","author":"Russell WS","year":"2013","unstructured":"Russell WS, Schuh AM, Hill JG, Hebra A, Cina RA, Smith CD, Streck CJ. Clinical practice guidelines for pediatric appendicitis evaluation can decrease computed tomography utilization while maintaining diagnostic accuracy. Pediatr Emerg Care. 2013, 29:568-73. 10.1097\/PEC.0b013e31828e5718","journal-title":"Pediatr Emerg Care"},{"key":"ref79","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2017.07.005","article-title":"Predicting need for additional CT scan in children with a non-diagnostic ultrasound for appendicitis in the emergency department","volume":"36","author":"Nishizawa T","year":"2018","unstructured":"Nishizawa T, Maeda S, Goldman RD, Hayashi H. Predicting need for additional CT scan in children with a non-diagnostic ultrasound for appendicitis in the emergency department. Am J Emerg Med. 2018, 36:49-55. 10.1016\/j.ajem.2017.07.005","journal-title":"Am J Emerg Med"},{"key":"ref80","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2411050913","article-title":"US or CT for diagnosis of appendicitis in children and adults? A meta-analysis","volume":"241","author":"Doria AS","year":"2006","unstructured":"Doria AS, Moineddin R, Kellenberger CJ, et al.. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 2006, 241:83-94. 10.1148\/radiol.2411050913","journal-title":"Radiology"},{"key":"ref81","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-016-5245-7","article-title":"Diagnosis and management of acute appendicitis. EAES consensus development conference 2015","volume":"30","author":"Gorter RR","year":"2016","unstructured":"Gorter RR, Eker HH, Gorter-Stam MA, et al.. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016, 30:4668-90. 10.1007\/s00464-016-5245-7","journal-title":"Surg Endosc"},{"key":"ref82","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12161","article-title":"Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort","volume":"20","author":"Mittal MK","year":"2013","unstructured":"Mittal MK, Dayan PS, Macias CG, et al.. Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Acad Emerg Med. 2013, 20:697-702. 10.1111\/acem.12161","journal-title":"Acad Emerg Med"},{"key":"ref83","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-012-2358-6","article-title":"A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography?","volume":"42","author":"Trout AT","year":"2012","unstructured":"Trout AT, Sanchez R, Ladino-Torres MF, Pai DR, Strouse PJ. A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography?. Pediatr Radiol. 2012, 42:813-23. 10.1007\/s00247-012-2358-6","journal-title":"Pediatr Radiol"},{"key":"ref84","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2018.11.019","article-title":"To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard","volume":"38","author":"Khan U","year":"2019","unstructured":"Khan U, Kitar M, Krichen I, Maazoun K, Althobaiti RA, Khalif M, Adwani M. To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard. Ann Med Surg (Lond). 2019, 38:22-7. 10.1016\/j.amsu.2018.11.019","journal-title":"Ann Med Surg (Lond)"},{"key":"ref85","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12631","article-title":"Properties of serial ultrasound clinical diagnostic pathway in suspected appendicitis and related computed tomography use","volume":"22","author":"Schuh S","year":"2015","unstructured":"Schuh S, Chan K, Langer JC, et al.. Properties of serial ultrasound clinical diagnostic pathway in suspected appendicitis and related computed tomography use. Acad Emerg Med. 2015, 22:406-14. 10.1111\/acem.12631","journal-title":"Acad Emerg Med"},{"key":"ref86","doi-asserted-by":"publisher","DOI":"10.1016\/j.mjafi.2016.02.005","article-title":"Imaging in acute appendicitis: what, when, and why?","volume":"73","author":"Debnath J","year":"2017","unstructured":"Debnath J, George RA, Ravikumar R. Imaging in acute appendicitis: what, when, and why?. Med J Armed Forces India. 2017, 73:74-9. 10.1016\/j.mjafi.2016.02.005","journal-title":"Med J Armed Forces India"},{"key":"ref87","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-020-00306-3","article-title":"Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines","volume":"15","author":"Di Saverio S","year":"2020","unstructured":"Di Saverio S, Podda M, De Simone B, et al.. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020, 15:27. 10.1186\/s13017-020-00306-3","journal-title":"World J Emerg Surg"},{"key":"ref88","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2008.12.003","article-title":"Improving diagnosis of acute appendicitis: results of a diagnostic pathway with standard use of ultrasonography followed by selective use of CT","volume":"208","author":"Poortman P","year":"2009","unstructured":"Poortman P, Oostvogel HJ, Bosma E, Lohle PN, Cuesta MA, de Lange-de Klerk ES, Hamming JF. Improving diagnosis of acute appendicitis: results of a diagnostic pathway with standard use of ultrasonography followed by selective use of CT. J Am Coll Surg. 2009, 208:434-41. 10.1016\/j.jamcollsurg.2008.12.003","journal-title":"J Am Coll Surg"},{"key":"ref89","doi-asserted-by":"publisher","DOI":"10.1542\/peds.110.6.1088","article-title":"Effect of an imaging protocol on clinical outcomes among pediatric patients with appendicitis","volume":"110","author":"Pe\u00f1a BM","year":"2002","unstructured":"Pe\u00f1a BM, Taylor GA, Fishman SJ, Mandl KD. Effect of an imaging protocol on clinical outcomes among pediatric patients with appendicitis. Pediatrics. 2002, 110:1088-93. 10.1542\/peds.110.6.1088","journal-title":"Pediatrics"},{"key":"ref90","article-title":"Diagnostic imaging strategies in pediatric appendicitis at tertiary and referring hospitals","volume":"2","author":"Hodgman EI","year":"2017","unstructured":"Hodgman EI, Wood JH, Burkhalter LS, Subramanian M, Styers JL, Khan N, Foglia RP. Diagnostic imaging strategies in pediatric appendicitis at tertiary and referring hospitals. Clin Surg. 2017, 2:1588.","journal-title":"Clin Surg"},{"key":"ref91","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012028.pub2","article-title":"Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis","volume":"12","author":"D'Souza N","year":"2021","unstructured":"D'Souza N, Hicks G, Beable R, Higginson A, Rud B. Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis. Cochrane Database Syst Rev. 2021, 12:CD012028. 10.1002\/14651858.CD012028.pub2","journal-title":"Cochrane Database Syst Rev"},{"key":"ref92","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2017162755","article-title":"Effectiveness of a staged US and unenhanced MR imaging algorithm in the diagnosis of pediatric appendicitis","volume":"286","author":"Dibble EH","year":"2018","unstructured":"Dibble EH, Swenson DW, Cartagena C, Baird GL, Herliczek TW. Effectiveness of a staged US and unenhanced MR imaging algorithm in the diagnosis of pediatric appendicitis. Radiology. 2018, 286:1022-9. 10.1148\/radiol.2017162755","journal-title":"Radiology"},{"key":"ref93","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2014.12.012","article-title":"An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis","volume":"50","author":"Kulaylat AN","year":"2015","unstructured":"Kulaylat AN, Moore MM, Engbrecht BW, et al.. An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis. J Pediatr Surg. 2015, 50:1359-63. 10.1016\/j.jpedsurg.2014.12.012","journal-title":"J Pediatr Surg"},{"key":"ref94","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-2128","article-title":"Ultrasonography\/MRI versus CT for diagnosing appendicitis","volume":"133","author":"Aspelund G","year":"2014","unstructured":"Aspelund G, Fingeret A, Gross E, et al.. Ultrasonography\/MRI versus CT for diagnosing appendicitis. Pediatrics. 2014, 133:586-93. 10.1542\/peds.2013-2128","journal-title":"Pediatrics"},{"key":"ref95","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.02.003","article-title":"Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement","volume":"134","author":"Page MJ","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al.. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021, 134:103-12. 10.1016\/j.jclinepi.2021.02.003","journal-title":"J Clin Epidemiol"},{"key":"ref96","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-020-04820-z","article-title":"Pediatric appendiceal ultrasound: maintaining accuracy, increasing determinacy and improving clinical outcomes following the introduction of a standardized reporting template","volume":"51","author":"Unsdorfer KM","year":"2021","unstructured":"Unsdorfer KM, An JY, Binkovitz LA. Pediatric appendiceal ultrasound: maintaining accuracy, increasing determinacy and improving clinical outcomes following the introduction of a standardized reporting template. Pediatr Radiol. 2021, 51:265-72. 10.1007\/s00247-020-04820-z","journal-title":"Pediatr Radiol"},{"key":"ref97","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000021961","article-title":"Computed tomography scan usage when US results are non-diagnostic for suspected acute appendicitis in children","volume":"99","author":"Kim I","year":"2020","unstructured":"Kim I, Kwon H, Choi YJ, et al.. Computed tomography scan usage when US results are non-diagnostic for suspected acute appendicitis in children. Medicine (Baltimore). 2020, 99:e21961. 10.1097\/MD.0000000000021961","journal-title":"Medicine (Baltimore)"},{"key":"ref98","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2019.10.039","article-title":"Accuracy of unenhanced, non-sedated MRI in the diagnosis of acute appendicitis in children","volume":"55","author":"Heye P","year":"2020","unstructured":"Heye P, Saavedra JS, Victoria T, Laje P. Accuracy of unenhanced, non-sedated MRI in the diagnosis of acute appendicitis in children. J Pediatr Surg. 2020, 55:253-6. 10.1016\/j.jpedsurg.2019.10.039","journal-title":"J Pediatr Surg"},{"key":"ref99","doi-asserted-by":"publisher","DOI":"10.51894\/001c.11639","article-title":"An evaluation of a community hospital's emergency department ultrasonography processes for the diagnosis of acute pediatric appendicitis","volume":"4","author":"Davis T","year":"2020","unstructured":"Davis T, Wisniewski SJ, Suidinski H, Betcher J. An evaluation of a community hospital's emergency department ultrasonography processes for the diagnosis of acute pediatric appendicitis. Spartan Med Res J. 2020, 4:11639. 10.51894\/001c.11639","journal-title":"Spartan Med Res J"},{"key":"ref100","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2018.1.36891","article-title":"Clinical ultrasound is safe and highly specific for acute appendicitis in moderate to high pre-test probability patients","volume":"19","author":"Corson-Knowles D","year":"2018","unstructured":"Corson-Knowles D, Russell FM. Clinical ultrasound is safe and highly specific for acute appendicitis in moderate to high pre-test probability patients. West J Emerg Med. 2018, 19:460-4. 10.5811\/westjem.2018.1.36891","journal-title":"West J Emerg Med"},{"key":"ref101","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-015-3432-7","article-title":"Pediatric appendiceal ultrasound: accuracy, determinacy and clinical outcomes","volume":"45","author":"Binkovitz LA","year":"2015","unstructured":"Binkovitz LA, Unsdorfer KM, Thapa P, et al.. Pediatric appendiceal ultrasound: accuracy, determinacy and clinical outcomes. Pediatr Radiol. 2015, 45:1934-44. 10.1007\/s00247-015-3432-7","journal-title":"Pediatr Radiol"},{"key":"ref102","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2015.03.012","article-title":"The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study?","volume":"50","author":"Cohen B","year":"2015","unstructured":"Cohen B, Bowling J, Midulla P, Shlasko E, Lester N, Rosenberg H, Lipskar A. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study?. AAP Paper. 2015, 50:923-7. 10.1016\/j.jpedsurg.2015.03.012","journal-title":"AAP Paper"},{"key":"ref103","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2015.01.034","article-title":"Integration of ultrasound findings and a clinical score in the diagnostic\u00a0evaluation of pediatric appendicitis","volume":"166","author":"Bachur RG","year":"2015","unstructured":"Bachur RG, Callahan MJ, Monuteaux MC, Rangel SJ. Integration of ultrasound findings and a clinical score in the diagnostic\u00a0evaluation of pediatric appendicitis. J Pediatr. 2015, 166:1134-9. 10.1016\/j.jpeds.2015.01.034","journal-title":"J Pediatr"},{"key":"ref104","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2021.07.064","article-title":"The use of a pediatric appendicitis pathway in a large integrated health system reduced computed tomography imaging in the ED","volume":"50","author":"Tunc E","year":"2021","unstructured":"Tunc E, Fraundorf E, Worley S, et al.. The use of a pediatric appendicitis pathway in a large integrated health system reduced computed tomography imaging in the ED. Am J Emerg Med. 2021, 50:211-7. 10.1016\/j.ajem.2021.07.064","journal-title":"Am J Emerg Med"},{"key":"ref105","doi-asserted-by":"publisher","DOI":"10.1111\/ped.13471","article-title":"Integration of radiology and clinical score in pediatric appendicitis","volume":"60","author":"Aydin D","year":"2018","unstructured":"Aydin D, Turan C, Yurtseven A, et al.. Integration of radiology and clinical score in pediatric appendicitis. Pediatr Int. 2018, 60:173-8. 10.1111\/ped.13471","journal-title":"Pediatr Int"},{"key":"ref106","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-016-3896-z","article-title":"Staged imaging pathway for the evaluation of pediatric appendicitis","volume":"32","author":"Chien M","year":"2016","unstructured":"Chien M, Habis A, Glynn L, O'Connor A, Smith TL, Prendergast F. Staged imaging pathway for the evaluation of pediatric appendicitis. Pediatr Surg Int. 2016, 32:671-8. 10.1007\/s00383-016-3896-z","journal-title":"Pediatr Surg Int"},{"key":"ref107","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.14.13212","article-title":"Value of focused appendicitis ultrasound and Alvarado score in predicting appendicitis in children: can we reduce the use of CT?","volume":"204","author":"Blitman NM","year":"2015","unstructured":"Blitman NM, Anwar M, Brady KB, Taragin BH, Freeman K. Value of focused appendicitis ultrasound and Alvarado score in predicting appendicitis in children: can we reduce the use of CT?. AJR Am J Roentgenol. 2015, 204:W707-12. 10.2214\/AJR.14.13212","journal-title":"AJR Am J Roentgenol"},{"key":"ref108","doi-asserted-by":"publisher","DOI":"10.1159\/000380772","article-title":"What is the acceptable rate of negative appendectomy? Comment on prospective evaluation of the added value of imaging within the Dutch National Diagnostic Appendicitis Guideline-do we forget our clinical eye","volume":"32","author":"Pape\u0161 D","year":"2015","unstructured":"Pape\u0161 D, Medan\u010di\u0107 SS, Antabak A, Sjekavica I, Lueti\u0107 T. What is the acceptable rate of negative appendectomy? Comment on prospective evaluation of the added value of imaging within the Dutch National Diagnostic Appendicitis Guideline-do we forget our clinical eye. Dig Surg. 2015, 32:181-2. 10.1159\/000380772","journal-title":"Dig Surg"},{"key":"ref109","article-title":"Pathologic evaluation of appendectomy specimens in children: is routine histopatholgic examination indicated?","volume":"21","author":"Monajemzadeh M","year":"2011","unstructured":"Monajemzadeh M, Hagghi-Ashtiani MT, Montaser-Kouhsari L, Ahmadi H, Zargoosh H, Kalantari M. Pathologic evaluation of appendectomy specimens in children: is routine histopatholgic examination indicated?. Iran J Pediatr. 2011, 21:485-90.","journal-title":"Iran J Pediatr"},{"key":"ref110","doi-asserted-by":"publisher","DOI":"10.1177\/1457496913519771","article-title":"Intraoperative motive for performing a laparoscopic appendectomy on a postoperative histological proven normal appendix","volume":"103","author":"Slotboom T","year":"2014","unstructured":"Slotboom T, Hamminga JT, Hofker HS, Heineman E, Haveman JW. Intraoperative motive for performing a laparoscopic appendectomy on a postoperative histological proven normal appendix. Scand J Surg. 2014, 103:245-8. 10.1177\/1457496913519771","journal-title":"Scand J Surg"},{"key":"ref111","article-title":"What is positive appendicitis? A new answer to an old question. Clinical, macroscopical and microscopical findings in 200 consecutive appendectomies","volume":"50","author":"Hussain A","year":"2009","unstructured":"Hussain A, Mahmood H, Singhal T, Balakrishnan S, El-Hasani S. What is positive appendicitis? A new answer to an old question. Clinical, macroscopical and microscopical findings in 200 consecutive appendectomies. Singapore Med J. 2009, 50:1145-9.","journal-title":"Singapore Med J"},{"key":"ref112","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.13536","article-title":"Primary omental torsion in children in the laparoscopy era: what have we learned so far?","volume":"38","author":"Alexopoulos V","year":"2024","unstructured":"Alexopoulos V, Sinopidis X, Louta A, et al.. Primary omental torsion in children in the laparoscopy era: what have we learned so far?. In Vivo. 2024, 38:1030-41. 10.21873\/invivo.13536","journal-title":"In Vivo"},{"key":"ref113","doi-asserted-by":"publisher","DOI":"10.1053\/j.semdp.2004.11.003","article-title":"Appendicitis and infections of the appendix","volume":"21","author":"Lamps LW","year":"2004","unstructured":"Lamps LW. Appendicitis and infections of the appendix. Semin Diagn Pathol. 2004, 21:86-97. 10.1053\/j.semdp.2004.11.003","journal-title":"Semin Diagn Pathol"},{"key":"ref114","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-006-0288-x","article-title":"Pathology of the appendix in children: an institutional experience and review of the literature","volume":"37","author":"Rabah R","year":"2007","unstructured":"Rabah R. Pathology of the appendix in children: an institutional experience and review of the literature. Pediatr Radiol. 2007, 37:15-20. 10.1007\/s00247-006-0288-x","journal-title":"Pediatr Radiol"},{"key":"ref115","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001127","article-title":"The American Association for the Surgery of Trauma grading scale for 16 emergency general surgery conditions: disease-specific criteria characterizing anatomic severity grading","volume":"81","author":"Tominaga GT","year":"2016","unstructured":"Tominaga GT, Staudenmayer KL, Shafi S, et al.. The American Association for the Surgery of Trauma grading scale for 16 emergency general surgery conditions: disease-specific criteria characterizing anatomic severity grading. J Trauma Acute Care Surg. 2016, 81:593-602. 10.1097\/TA.0000000000001127","journal-title":"J Trauma Acute Care Surg"},{"key":"ref116","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2016.12.017","article-title":"A classification system to grade all appendicitis","volume":"52","author":"Hernandez MC","year":"2017","unstructured":"Hernandez MC, Shafi S, Zielinski MD. A classification system to grade all appendicitis. J Pediatr Surg. 2017, 52:665. 10.1016\/j.jpedsurg.2016.12.017","journal-title":"J Pediatr Surg"},{"key":"ref117","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.14.1748","article-title":"Has misdiagnosis of appendicitis decreased over time? A population-based analysis","volume":"286","author":"Flum DR","year":"2001","unstructured":"Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001, 286:1748-53. 10.1001\/jama.286.14.1748","journal-title":"JAMA"},{"key":"ref118","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2015.10.25576","article-title":"Abdominal CT does not improve outcome for children with suspected acute appendicitis","volume":"16","author":"Miano DI","year":"2015","unstructured":"Miano DI, Silvis RM, Popp JM, Culbertson MC, Campbell B, Smith SR. Abdominal CT does not improve outcome for children with suspected acute appendicitis. West J Emerg Med. 2015, 16:974-82. 10.5811\/westjem.2015.10.25576","journal-title":"West J Emerg Med"},{"key":"ref119","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2012.09.018","article-title":"Managing radiation exposure in children--reexamining the role of ultrasound in the diagnosis of appendicitis","volume":"47","author":"Thirumoorthi AS","year":"2012","unstructured":"Thirumoorthi AS, Fefferman NR, Ginsburg HB, Kuenzler KA, Tomita SS. Managing radiation exposure in children--reexamining the role of ultrasound in the diagnosis of appendicitis. J Pediatr Surg. 2012, 47:2268-72. 10.1016\/j.jpedsurg.2012.09.018","journal-title":"J Pediatr Surg"},{"key":"ref120","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00511.x","article-title":"An interdisciplinary initiative to reduce radiation exposure: evaluation of appendicitis in a pediatric emergency department with clinical assessment supported by a staged ultrasound and computed tomography pathway","volume":"16","author":"Ramarajan N","year":"2009","unstructured":"Ramarajan N, Krishnamoorthi R, Barth R, Ghanouni P, Mueller C, Dannenburg B, Wang NE. An interdisciplinary initiative to reduce radiation exposure: evaluation of appendicitis in a pediatric emergency department with clinical assessment supported by a staged ultrasound and computed tomography pathway. Acad Emerg Med. 2009, 16:1258-65. 10.1111\/j.1553-2712.2009.00511.x","journal-title":"Acad Emerg Med"},{"key":"ref121","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S134153","article-title":"Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis","volume":"13","author":"Sayed AO","year":"2017","unstructured":"Sayed AO, Zeidan NS, Fahmy DM, Ibrahim HA. Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis. Ther Clin Risk Manag. 2017, 13:847-54. 10.2147\/TCRM.S134153","journal-title":"Ther Clin Risk Manag"}],"container-title":["Cureus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cureus.com\/articles\/351804-balancing-between-negative-appendectomy-and-complicated-appendicitis-a-persisting-reality-under-the-rule-of-the-uncertainty-principle","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T16:56:22Z","timestamp":1743440182000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cureus.com\/articles\/351804-balancing-between-negative-appendectomy-and-complicated-appendicitis-a-persisting-reality-under-the-rule-of-the-uncertainty-principle"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,31]]},"references-count":121,"URL":"https:\/\/doi.org\/10.7759\/cureus.81516","relation":{},"ISSN":["2168-8184"],"issn-type":[{"value":"2168-8184","type":"print"}],"subject":[],"published":{"date-parts":[[2025,3,31]]}}}