Title: Development of a scoring model based on objective factors to predict gangrenous/
perforated appendicitis
Version: 1 Date: 01 Jan 2023
Reviewer:  Rodrigo Moises De Almeida Leite
Reviewer's report:
The authors are presenting a novel score to predict gangrenous or perforated appendicitis.
The  three variables used in this score ( appendix diameter, C-reactive protein and presence of
appendicoliths ) are easily reproducible and objectively observed, leading to an easy application
of this tool in clinical practice.
A low ( 0 or 1 score ) has presented a high enough sensitivity such as to rule out the presence of
perforation or gangrene. On the opposite, an score of 3 brought about a very high specificity  to
diagnose these two forms of appendicitis complication. Doubt remains about score 2 ( of note
highly prevalent in the study population ), which has added little to no value in predicting or
excluding the main outcome of the event. Other concern is the study population itself, being it a
single center, in specific demographic of Asian patients. Larger studies, preferably prospective
in design, including different populations are needed before widespread use of this tool .
In summary, I recommend the manuscript for publication with the inclusion further discussion
about the above mentioned limitations.
Title: Development of a scoring model based on objective factors to predict gangrenous/
perforated appendicitis
Version: 1 Date: 01 Jan 2023
Reviewer:  Rodrigo Moises De Almeida Leite
Reviewer's report:
The authors are presenting a novel score to predict gangrenous or perforated appendicitis.
The  three variables used in this score ( appendix diameter, C-reactive protein and presence of
appendicoliths ) are easily reproducible and objectively observed, leading to an easy application
of this tool in clinical practice.
A low ( 0 or 1 score ) has presented a high enough sensitivity such as to rule out the presence of
perforation or gangrene. On the opposite, an score of 3 brought about a very high specificity  to
diagnose these two forms of appendicitis complication. Doubt remains about score 2 ( of note
highly prevalent in the study population ), which has added little to no value in predicting or
excluding the main outcome of the event. Other concern is the study population itself, being it a
single center, in specific demographic of Asian patients. Larger studies, preferably prospective
in design, including different populations are needed before widespread use of this tool .
In summary, I recommend the manuscript for publication with the inclusion further discussion
about the above mentioned limitations.
Please review this paper.
user
Title: Development of a scoring model based on objective factors to predict gangrenous/
perforated appendicitis
Version: 1 Date: 01 Jan 2023
Reviewer:  Rodrigo Moises De Almeida Leite
Reviewer's report:
The authors are presenting a novel score to predict gangrenous or perforated appendicitis.
The  three variables used in this score ( appendix diameter, C-reactive protein and presence of
appendicoliths ) are easily reproducible and objectively observed, leading to an easy application
of this tool in clinical practice.
A low ( 0 or 1 score ) has presented a high enough sensitivity such as to rule out the presence of
perforation or gangrene. On the opposite, an score of 3 brought about a very high specificity  to
diagnose these two forms of appendicitis complication. Doubt remains about score 2 ( of note
highly prevalent in the study population ), which has added little to no value in predicting or
excluding the main outcome of the event. Other concern is the study population itself, being it a
single center, in specific demographic of Asian patients. Larger studies, preferably prospective
in design, including different populations are needed before widespread use of this tool .
In summary, I recommend the manuscript for publication with the inclusion further discussion
about the above mentioned limitations.
assistant