In Reply We read with interest the concerns raised by Bonadio in response to our study¹ examining the relationship between treatment delay and complicated appendicitis. First and foremost, we would disagree with the premise that a lack of knowledge regarding perforation status at presentation undermines the study’s validity. Use of mixed-effects hierarchical regression modeling to control for differences (ie, clustering) in perforation rates within hospitals allows for the assessment of postpresentation treatment delay across hospitals without knowledge of each hospitals’ specific baseline rate. Furthermore, we explored the relationship between treatment delay and adverse outcomes at the level of 23 individual hospitals, collectively representing a broad range of diagnostic practices and time-to-appendectomy profiles. The results were no different with the hospital-level analyses, and no increased risk of complicated disease was found even at hospitals with relatively long treatment delays.

在答复中我们感兴趣地阅读了Bonadio针对我们的研究¹提出的关注检查延迟治疗与复杂性阑尾炎之间的关系。首先，我们不同意这样的前提，即在呈现时缺乏有关穿孔状态的知识会损害研究的有效性。使用混合效果分层回归模型来控制医院中穿孔率的差异（即，聚类）可在不了解每家医院特定基线率的情况下评估各医院在演示后的治疗延迟。此外，我们在23家个体医院的水平上探讨了治疗延迟和不良结局之间的关系，共同代表了广泛的诊断方法和阑尾切除术时间。结果与医院水平的分析没有什么不同，