Title: Predictive Model for Identification of Gangrenous or Perforated Appendicitis in Adults:
A Multicenter Retrospective Study
Version: 6 Date: 03 Aug 2024
Reviewer's report:
Dear authors
thank you for revising this manuscript. I think it has been quite improved by the revisions and
particular the discussion is more sound and put better in the context of existing literature.
Most of my comments have been implemented to my satisfaction. I strongly disagree with
your response to the CRP given that CRP by itself has an AUC of around 0.80 to discriminate
complicated from uncomplicated appendicitis and I suspect you just did not have CRP available
because it was not routinely done. At the same time PCT is an excellent marker for blood
stream infections and presence of bacterial debris in the blood stream and not at all validated
for Appendicitis but given that this was not significant in your model anyway I don't think we
need to go into further discussion about it.
In your response you say you used unenhanced CT. I presume this means non-contrast and
should thus be also in the manuscript. Most people use a contrast scan with a low dose protocol
for younger adults nowadays so I just need you to mention this precisely.
You have also revised your methods and it has become clearer now what you have done. In
order to properly describe your model however, you should explain what kind of regression was
done, I presume its binominal logistic stepwise? please report chi 2 and omnibus p value for the
overall model and give a nagelkerke / cox and snell R2 in percentage.
Further to this there is still no explanation how the nomogram was created and how it is applied.
These two things are an absolute must for this to be published and you must have this data thus
I wonder why it is not reported here.
Thank you for revising this manuscript and for including the statistical limitations. I do think
this is a valuable study and only a few more things need to be done for this to be publishable. I
also think Figures 4  and 5 are unnecessary and could be moved to supplementary materials
Title: Predictive Model for Identification of Gangrenous or Perforated Appendicitis in Adults:
A Multicenter Retrospective Study
Version: 6 Date: 03 Aug 2024
Reviewer's report:
Dear authors
thank you for revising this manuscript. I think it has been quite improved by the revisions and
particular the discussion is more sound and put better in the context of existing literature.
Most of my comments have been implemented to my satisfaction. I strongly disagree with
your response to the CRP given that CRP by itself has an AUC of around 0.80 to discriminate
complicated from uncomplicated appendicitis and I suspect you just did not have CRP available
because it was not routinely done. At the same time PCT is an excellent marker for blood
stream infections and presence of bacterial debris in the blood stream and not at all validated
for Appendicitis but given that this was not significant in your model anyway I don't think we
need to go into further discussion about it.
In your response you say you used unenhanced CT. I presume this means non-contrast and
should thus be also in the manuscript. Most people use a contrast scan with a low dose protocol
for younger adults nowadays so I just need you to mention this precisely.
You have also revised your methods and it has become clearer now what you have done. In
order to properly describe your model however, you should explain what kind of regression was
done, I presume its binominal logistic stepwise? please report chi 2 and omnibus p value for the
overall model and give a nagelkerke / cox and snell R2 in percentage.
Further to this there is still no explanation how the nomogram was created and how it is applied.
These two things are an absolute must for this to be published and you must have this data thus
I wonder why it is not reported here.
Thank you for revising this manuscript and for including the statistical limitations. I do think
this is a valuable study and only a few more things need to be done for this to be publishable. I
also think Figures 4  and 5 are unnecessary and could be moved to supplementary materials
Please review this paper.
user
Title: Predictive Model for Identification of Gangrenous or Perforated Appendicitis in Adults:
A Multicenter Retrospective Study
Version: 6 Date: 03 Aug 2024
Reviewer's report:
Dear authors
thank you for revising this manuscript. I think it has been quite improved by the revisions and
particular the discussion is more sound and put better in the context of existing literature.
Most of my comments have been implemented to my satisfaction. I strongly disagree with
your response to the CRP given that CRP by itself has an AUC of around 0.80 to discriminate
complicated from uncomplicated appendicitis and I suspect you just did not have CRP available
because it was not routinely done. At the same time PCT is an excellent marker for blood
stream infections and presence of bacterial debris in the blood stream and not at all validated
for Appendicitis but given that this was not significant in your model anyway I don't think we
need to go into further discussion about it.
In your response you say you used unenhanced CT. I presume this means non-contrast and
should thus be also in the manuscript. Most people use a contrast scan with a low dose protocol
for younger adults nowadays so I just need you to mention this precisely.
You have also revised your methods and it has become clearer now what you have done. In
order to properly describe your model however, you should explain what kind of regression was
done, I presume its binominal logistic stepwise? please report chi 2 and omnibus p value for the
overall model and give a nagelkerke / cox and snell R2 in percentage.
Further to this there is still no explanation how the nomogram was created and how it is applied.
These two things are an absolute must for this to be published and you must have this data thus
I wonder why it is not reported here.
Thank you for revising this manuscript and for including the statistical limitations. I do think
this is a valuable study and only a few more things need to be done for this to be publishable. I
also think Figures 4  and 5 are unnecessary and could be moved to supplementary materials
assistant