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New research · Pediatrics
BMC pediatrics · 1d
Cohort studyBMC pediatrics · 2026

Integration of clinical information for identification of gangrenous or perforated appendicitis in children: a multicenter retrospective cohort study with external validation.

Honglong Ma, Junjun Ouyang, Jie Liu … Lang Cheng
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PediatricsCohort study

A new nomogram accurately identifies complicated appendicitis in children.

Integration of clinical information for identification of gangrenous or perforated appendicitis in children: a multicenter retrospective cohort study with external validation.

Honglong Ma et al. · BMC pediatrics · 2026
Background

Acute complicated appendicitis in children is associated with substantial morbidity, including prolonged hospitalization, abscess formation, higher rates of surgical site infection, postoperative ileus, chronic abdominal pain, and increased need for reoperation.

Purpose

This study aimed to identify reliable preoperative predictors of acute complicated appendicitis in childrenand to develop an accurate, clinically practical predictive nomogram.

Methods

Were randomly divided into a training cohort and an internal validation cohort in a 7:3 ratio.

n = 450 patients
Results

the nomogram was very good at identifying complicated appendicitis in children

0.922
training
0.916
internal validation
0.906
external validation
More results

Nine significant preoperative predictors were identified: neutrophil-to-lymphocyte ratio, C-reactive protein level, serum chloride, fibrinogen, appendicolith, free peritoneal effusion, onset time, peritoneal irritation signs, and fever(≥ 38 °C).

More results

Additionally, the model showed excellent calibration and significant clinical utility, as demonstrated by decision curve analysis across all cohorts.

“
Conclusion · 1 of 2

This study successfully developed and validated a high-performance nomogram that effectively distinguishes between acute complicated and uncomplicated appendicitis in children.

Conclusion · 2 of 2

This tool may assist clinicians in early risk stratification and could contribute to improved patient outcomes.

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