Evaluation of Ultrasound Accuracy in Acute Appendicitis Diagnosis

Round 1

Reviewer 1 Report

Thanks for the opportunity to review this paper on use of US in diagnosis of appendicitis. I have a few questions and comments

1.Over what period of time was study conducted?

2.Table 1- repetition of 21-40 age group

3.Table 2 accurate diagnosis adds to 66 while manuscript mentions 65

4.I failed to understand what table 3 was about. inaccurate meaning US missed finding?

5.I disagree with first sentence of discussion. Ultrasound should be used to supplement clinical findings when they are not definitive for appendicitis. It should not replace physical examination.

6.Was here a difference in ability to visualise appendix based on years of experience of the sonographer. More time spent on looking for appendix is also likely to improve visualisation of appendix. Similarly BMI also has an influence on visualising appendix. Unfortunately this detail was not available in this study. From the last para of the discussion it appears use of  US has recently been practice and this may contributed to poor accuracy. Is it likely to improve with increased use. I agree with authors that it should be used as a rule in test.

Author Response

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Reviewer 2 Report

A retrospective study was conducted to assess the diagnostic accuracy of ultrasound in acute appendicitis. A conclusion is made that the ultrasound diagnostic accuracy was low for assessing the acute appendicitis. It is an interesting research although the conclusion is negative.

For the readers to understand this research, some typical ultrasound images for patients are needed. In addition, the specific diagnostic features, such as the size of the appendix or thickness of wall should be analyzed. The conflict features such as free fluid or no free fluid should be discussed or removed if irrelevant.

Author Response

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Reviewer 3 Report

Ultrasonic sonography is a widely used and well recognized tool in clinical diagnosis of appendicitis. The conclusion of the authors does somehow contradict the common knowledge regarding this medical modality for the acute appendicitis and provides a different view. Of course, the accuracy of diagnosis is related to a few factors such the experience of the physicians, machine used, and especially the criteria of determination of the inflammation etc. To be more objective and non-biased in making judgement I think the criteria should be more clearly stated, i.e., by what standard the case can be determined compared to other popular standards like Alvarado score or CT (comparison of the images from US and CT is helpful). The manuscript is written in a concise way, it seems there is space for more explanation. Below are some other minor suggestions for correction to the authors:

1. The English used in the manuscript is not following the style of academic writing. The grammar check has to be done thoroughly and maybe professional editing can help greatly.
2. Table 1. Age range 1-20 is repeated. Figure 3 the dots are not defined in the legend.
3. In the use of statistics terms (sensitivity, specificty...) the authors should be clearly defined for e.g. how the xi-square is done.

Author Response

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Round 2

Reviewer 2 Report

The authors have improved the manuscript.