Parental Knowledge of Appendicitis and Preference for Operative or Non-Operative Treatment at a United Kingdom Children’s Hospital

Round 1

Reviewer 1 Report

-In introduction: “ In the UK approx mately 10,000 cases in children are treated annually [1]. Try to refer to the main source of this statistics information.

- In methods: why did you use age of 16 as a cut off? Kindly give a short explanation in the methods section for the international readers

- In methods also you should specify the time period of the study

 - In results: “No significant associations were identified between age or gender of respondent, or previous experience (knowing someone) with appendicitis, and treatment preference.” Give more details about the previous experience and the association with knowledge of appendicitis

- In discussion: why do not you discuss the effect of lack of knowledge about the location of the appendix and the self assessment of acute abdomen and the danger of detection delay?

- In discussion also you should refer to the causes of the acute appendicitis pain mimics  (eg; 1)Enterobius infestation “you can get help and cite: Hasan A, et al. Enterobius vermicularis in appendectomy specimens; Clinicopathological assessment: cross sectional study. Annals of Medicine and Surgery. 2020 Dec 1;60:168-72. 2) ovarian cysts: Sargar KM, Siegel MJ. Sonography of acute appendicitis and its mimics in children. Indian Journal of Radiology and Imaging. 2014 May;24(02):163-70, ……)

Author Response

Thank you for your helpful comments on our manuscript and please find a revised version attached. With specific reference to your comments:

• we have added to original source for this statistic
• we used age 16 as a cut off since this is the upper age limit of children seen in our outpatient clinic; we have added an explanation for this to the revised manuscript
• we have added the time period for the study to the revised manuscript
• regarding relationship between previous experience of appendicitis and knowledge about the disease, we have added a short paragraph to the results section and a figure to the supplementary material
• we did not previously focus on the clinical aspects of our findings as our focus was around information provision but of course you are correct and we have added a section on clinical implications to a revised manuscript.
• regarding your suggestion about causes of abdominal pain, we agree that there are many causes of abdominal pain, only one of which is appendicitis. However, we did not have a question specifically about pain in our survey and so we do not feel that discussion of this is justified. Respectfully, therefore we have not made any changes in relation to this comment.

Reviewer 2 Report

Thanks for the opportunity to review this retrospective study measuring inter and intraobserver variation in US measurement of ARA.

I have the following questions?

1. Where the all patients included in this study part of your previous study? If so is the study biased?

2.Where the patients matched for age and duration from time of delivery? This may be of importance if the ARA changes significantly with age and time from injury? Some more detail of how you selectd patietns may be useful

3. Are the measurements done at rest, valsalva and contraction once or is the study repeated more than once on each occasion and average taken?

It is an interesting paper.

Author Response

We believe there is an error and this review is not of our manuscript so have not responded to these comments.

Reviewer 3 Report

The authors should be complimented for this very interesting paper on parental knowledge of appendicitis in the UK. This manuscript is perfectly written. It is clear and concise and the study protocol is strong with no major issues. I appreciated a lot the use of a PPI in the protocol. It would be very interesting for a future national survey in the UK to respond to any geographical bias, the authors should think about it.

Regarding this manuscript I would suggest only two very minor corrections:

• SPSS is not correctly reported, please state as IBM SPSS Statistics for Windows, version 28.1 (IBM Corp., Armonk, NY, USA). 
• Table 2 title is wrong

Congratulations on the efforts of this study. After these minor corrections, I believe publication is possible straightforward.

Author Response

Thank you for your helpful comments on our manuscript and please find a revised version attached. With specific reference to your comments:

• We agree there may be regional bias and have acknowledged this as a potential limitation of our work
• We have amended the reporting of SPSS
• We have amended the title for Table 2 and thank the reviewer for highlighting this error.