Inter-Rater Reliability Of Assigning A Pediatric Appendicitis Grade: An International Multicenter Study By The...

Area of Science:

• Pediatric Surgery
• Surgical Outcomes Research
• Medical Diagnostics

Background:

• Appendicitis classification often lacks risk stratification, simplifying cases into simple versus perforated.
• Current methods for assessing appendicitis severity may not adequately differentiate patient risk.
• There is a need for a standardized system to grade appendicitis severity in children.

Purpose of the Study:

• To evaluate the inter-rater reliability of the Pediatric Appendicitis Grade (PAG) system.
• To determine if the PAG system can be reliably applied by various surgical personnel.
• To assess the utility of the PAG system in a global context for pediatric appendectomy.

Main Methods:

• An international study involving pediatric surgery staff and trainees from 29 institutions across 6 continents.
• Participants rated 15 edited laparoscopic appendectomy videos representing different PAG levels.
• Inter-observer reliability was calculated using the intraclass correlation coefficient (ICC).

Main Results:

• The overall accuracy of PAG assignment was 71%, with higher accuracy for lower grades (PAG 1: 97%) and lower for higher grades (PAG 5: 51%).
• The ICC was 0.81, indicating good inter-rater reliability.
• Reliability was consistent across attending surgeons versus trainees and varied practice volumes.

Conclusions:

• The Pediatric Appendicitis Grade (PAG) system is reliably assignable by surgeons and trainees globally.
• Routine adoption of the PAG system can improve prognostication and benchmarking for pediatric appendicitis.
• Standardized grading facilitates better outcomes reporting and resource allocation for this common pediatric surgical condition.