Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome
IntroductionSome studies have shown poor agreement between intraoperative and histopathological classifications for appendicitis, despite their routine use in clinical practice.ObjectiveTo investigate the agreement between histopathological and intraoperative classifications for pediatric appendicit...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.908226/full |
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| author | Camila de Paula Silva Erika Veruska Paiva Ortolan Sergio Marrone Ribeiro Bruna Aliotto Nalin Tedesco Simone Antunes Terra Maria Aparecida Marchesan Rodrigues Pedro Luiz Toledo de Arruda Lourenção |
| author_facet | Camila de Paula Silva Erika Veruska Paiva Ortolan Sergio Marrone Ribeiro Bruna Aliotto Nalin Tedesco Simone Antunes Terra Maria Aparecida Marchesan Rodrigues Pedro Luiz Toledo de Arruda Lourenção |
| author_sort | Camila de Paula Silva |
| collection | DOAJ |
| description | IntroductionSome studies have shown poor agreement between intraoperative and histopathological classifications for appendicitis, despite their routine use in clinical practice.ObjectiveTo investigate the agreement between histopathological and intraoperative classifications for pediatric appendicitis and evaluate the predictive potential of these classifications for the post-operative outcome.MethodsA 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.Results43.9% 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 (0.337–0.501). There was an association (P < 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.ConclusionThe agreement between the two classifications was moderate, and the intraoperative classification was able to predict the post-operative clinical outcomes. |
| first_indexed | 2024-04-13T19:28:54Z |
| format | Article |
| id | doaj.art-4cee216ff3944456a182f78d7ca087de |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-13T19:28:54Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-4cee216ff3944456a182f78d7ca087de2022-12-22T02:33:15ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-08-011010.3389/fped.2022.908226908226Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcomeCamila de Paula Silva0Erika Veruska Paiva Ortolan1Sergio Marrone Ribeiro2Bruna Aliotto Nalin Tedesco3Simone Antunes Terra4Maria Aparecida Marchesan Rodrigues5Pedro Luiz Toledo de Arruda Lourenção6Department of Infectious Diseases, Dermatology, Diagnostic Imaging, and Radiotherapy, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, BrazilDivision of Pediatric Surgery, Department of Surgery and Orthopedics, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, BrazilDepartment of Infectious Diseases, Dermatology, Diagnostic Imaging, and Radiotherapy, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, BrazilDivision of Pediatric Surgery, Department of Surgery and Orthopedics, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, BrazilDepartment of Pathology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, BrazilDepartment of Pathology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, BrazilDivision of Pediatric Surgery, Department of Surgery and Orthopedics, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, BrazilIntroductionSome studies have shown poor agreement between intraoperative and histopathological classifications for appendicitis, despite their routine use in clinical practice.ObjectiveTo investigate the agreement between histopathological and intraoperative classifications for pediatric appendicitis and evaluate the predictive potential of these classifications for the post-operative outcome.MethodsA 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.Results43.9% 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 (0.337–0.501). There was an association (P < 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.ConclusionThe agreement between the two classifications was moderate, and the intraoperative classification was able to predict the post-operative clinical outcomes.https://www.frontiersin.org/articles/10.3389/fped.2022.908226/fullappendicitispediatricintraoperative appendicitis classificationhistological appendicitis classificationappendicitis clinical outcome |
| spellingShingle | Camila de Paula Silva Erika Veruska Paiva Ortolan Sergio Marrone Ribeiro Bruna Aliotto Nalin Tedesco Simone Antunes Terra Maria Aparecida Marchesan Rodrigues Pedro Luiz Toledo de Arruda Lourenção Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome Frontiers in Pediatrics appendicitis pediatric intraoperative appendicitis classification histological appendicitis classification appendicitis clinical outcome |
| title | Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome |
| title_full | Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome |
| title_fullStr | Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome |
| title_full_unstemmed | Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome |
| title_short | Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome |
| title_sort | agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post operative clinical outcome |
| topic | appendicitis pediatric intraoperative appendicitis classification histological appendicitis classification appendicitis clinical outcome |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.908226/full |
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