In our previous and current studies; all patients underwent the a

In our previous and current studies; all patients underwent the active watchful waiting strategy. This excludes that the decision-making process did result strictly from the MCPGS, and was not rather based on the repeated clinical re-evaluation that was adopted also on CPGS. This exactly shows that our proposed score is superior to the real

life common clinical practice. It may be concluded that the use of selleckchem a modified clinical and THI ultrasonographic grading score (MCPGS) with the rationale of active watchful waiting in suspected appendicitis with at least one time repetition of THI-US was a prudent and safe strategy. It may improve the accuracy of diagnosing acute appendicitis in the pediatric population as it is superior to the real life common clinical practice. It leads to fewer negative appendectomies compared with those children

to whom it was not applied or other scoring systems were applied as the CPGS with the same strategy of active watchful waiting and repeated US, without a significant change in the perforation rate. Moreover, inpatient observation for serial examinations was reduced significantly. Our clinical Wortmannin research buy practice grading scores can have considerable impact on the diagnosis of acute appendicitis in children. A larger cohort is necessary to validate our findings. Acknowledgements We would like to acknowledge Dr Essam Abd

El Bari and Dr. M Yasser Ibrahim for their assistance in revising the manuscript. References 1. Zakaria OM, Adly OA, El-Labban GA, Khalil HT: Acute Appendicitis else In Children: A Clinical Practice Guideline Scoring System. Suez Canal Univ Med J 2005, 8:20–26. 2. François Y, Bonvoisin S, Descos L, Vignal J: Prospective study of a predictive scoring system for the diagnosis of appendicitis in patients with right lower quadrant pain. Long-term outcome]. Gastroenterol Clin Biol 1991, 15:794–799.PubMed 3. Samuel M: Pediatric appendicitis score. J Pediatr Surg 2002, 37:877–881.PubMedCrossRef 4. Rezak A, Abbas HM, Ajemian MS, Dudrick SJ, Kwasnik EM: Decreased use of computed tomography with a modified clinical scoring system in diagnosis of pediatric acute appendicitis. Arch Surg 2011, 146:64–67.PubMedCrossRef 5. Dado G, Anania G, Baccarani U, Marcotti E, Donini A, Risaliti A, Pasqualucci A, Bresadola F: Application of a clinical score for the diagnosis of acute appendicitis in childhood: A retrospective analysis of 197 patients. J Pediatr Surg 2000, 35:1320–1322.PubMedCrossRef 6. Escribá A, Gamell AM, Fernández Y, Quintillá JM, Cubells CL: Prospective validation of two systems of classification for the diagnosis of acute appendicitis. Pediatr Emerg Care 2011, 27:165–169.PubMedCrossRef 7.

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