Response to the Letter on "Plasma Sodium and Laboratory Parameters in Determining Complicated Appendicitis in Children"

Abstract

We are very grateful to the authors of the letter regarding our article, published in Medical Principles and Practice. We truly appreciate their comments and criticism. It is worthwhile knowing that it induced the interest of experts in the field. This retrospective study aimed to bring additional evidence on how blood test results can be utilized in discrimination between complicated and uncomplicated acute appendicitis (AA) in children. The study had several limitations as we provided in the published article and pointed out in the letter related to the article. The letter pointed out that "Sensitivity, specificity, accuracy, positive predictive values, and negative predictive values were not calculated or presented for sodium, CRP, and WBC tests" . This was due to the retrospective nature of the study. We had no opportunity to obtain data about the used diagnostic tests; only results and reference intervals were available. Also, in the letter, it is pointed out that "continuous variables to determine optimal cutoff points for distinguishing uncomplicated acute appendicitis (UAA) and CAA are incomplete." As stated in the article, "the study included only one clinical center, and there was missing data for laboratory analyses for certain patients that could lead to misinterpretation" [1]. Due to the large proportion of missing data, several variables were not included in the model (neutrophils; lymphocyte levels; and concentrations of calcium, chloride, and total bilirubin). However, the data were complete for sodium and CRP, while only one (0.4%) patient had missing WBC data, and those variables were included in the model.