Details

Autor(en) / Beteiligte

• Pham, Xuan-Binh D., MD
• Sullins, Veronica F., MD
• Kim, Dennis Y., MD
• Range, Blake
• Kaji, Amy H., MD, PhD
• de Virgilio, Christian M., MD
• Lee, Steven L., MD

Titel

Factors Predictive of Complicated Appendicitis in Children

Ist Teil von

• The Journal of surgical research, 2016-11, Vol.206 (1), p.62-66

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2016

Quelle

ScienceDirect

Beschreibungen/Notizen

• Abstract Background The ability to predict whether a child has complicated appendicitis at initial presentation may influence clinical management. However, whether complicated appendicitis is associated with pre-hospital or in-hospital factors are not clear. We also investigate whether hyponatremia may be a novel pre-hospital factor associated with complicated appendicitis. Materials and methods A retrospective review of all pediatric patients ( < 12 years) with appendicitis treated with appendectomy from 2000-2013 was performed. The main outcome measure was intraoperative confirmation of gangrenous or perforated appendicitis. A multivariable analysis was performed and the main predictors of interest were age <5 years, symptom duration >24 hours, leukocytosis (WBC count >12 x103 /ml), hyponatremia (sodium < 135 mEq/L), and time from admission to appendectomy. Results Of 392 patients, 179 (46%) had complicated appendicitis at the time of operation. Univariate analysis demonstrated that patients with complicated appendicitis were younger, had a longer duration of symptoms, higher WBC count, and lower sodium levels than patients with non-complicated appendicitis. Multivariable analysis confirmed that symptom duration >24 hours (OR = 5.5, 95% CI = 3.5-8.9, P <.01), hyponatremia (OR = 3.1, 95% CI = 2.0-4.9, P <.01), age <5 years (OR = 2.3, 95% CI = 1.3-4.0, P <.01), and leukocytosis (OR = 1.9, 95% CI = 1.0-3.5, P = .04) were independent predictors of complicated appendicitis. Increased time from admission to appendectomy was not a predictor of complicated appendicitis (OR = 0.8, 95% CI = 0.5-1.2, P = 0.2). Conclusions Pre-hospital factors can predict complicated appendicitis in children with suspected appendicitis. Hyponatremia is a novel marker associated with complicated appendicitis. Delaying appendectomy does not increase the risk of complicated appendicitis once intravenous antibiotics are administered. This information may help guide resource/personnel allocation, timing of appendectomy, and decision for non-operative management of appendicitis in children.