In Reply We appreciate the attention, comments, and questions on our article¹ in JAMA Pediatrics. Regarding Bonadio’s first question, we would agree that criteria for adults are not always applicable for children. The references Bonadio cited, which showed nonappendicitis had a normal measured appendiceal diameter of greater than 6 mm, were adult-based studies. For children, 6 mm is a critical diagnostic criterion for acute appendicitis (AA).² Meanwhile, diagnosis for AA is mainly based on clinical findings combined with imaging examination. The inclusion criteria of studies were comprehensive; appendiceal dilation as 6 to 11 mm is part of the criteria, which was defined to exclude either complicated appendicitis or normal appendix. But it could be possible that nearly normal or milder appendicitis be included in nonoperative treatment (NOT) group, so risk-stratified scoring system^3,4 should be used for ultrasonography examination, providing more detailed information for the precision diagnosis of AA.

在回复我们欣赏的目光，评论，以及对我们的文章问题¹中JAMA小儿科。关于Bonadio的第一个问题，我们同意成人标准并不总是适用于儿童。引用的Bonadio参考文献表明，非阑尾炎的正常阑尾直径大于6毫米，是基于成人的研究。对于儿童，6毫米是急性阑尾炎（AA）的关键诊断标准。^2个同时，AA的诊断主要基于临床表现并结合影像学检查。研究的纳入标准是全面的；阑尾扩张为6至11毫米是该标准的一部分，该标准被定义为排除复杂性阑尾炎或正常阑尾。但是非手术治疗（NOT）组可能包括接近正常或较轻度的阑尾炎，因此超声检查应使用风险分层评分系统^{3，4 ，}为AA的精确诊断提供更详细的信息。