Original ContributionEffect of delay in presentation on rate of perforation in children with appendicitis
Introduction
Appendicitis is the most common emergency that requires surgical intervention in children. In the United States, more than 341 000 open or laparoscopic appendectomies are performed each year [1]. Children tend to have higher rates of appendiceal perforation than do adults [2], [3], [4]. Several factors may contribute to this observation. First, children may present with a variety of atypical symptoms, in contrast with the classic periumbilical pain that later migrates to the right lower quadrant. In addition, very young children may have little omentum and intraabdominal fat, allowing peritoneal spread to occur more readily [5], [6]. Finally, children tend to present later than adults, thereby causing a delay in diagnosis that contributes to a higher perforation rate [6].
In 2006, Bickell et al [7] studied the effect of the duration of symptoms on the risk of rupture in 219 adult patients. The study suggested that the risk of rupture rises to 5% after the first 36 hours and remains unchanged thereafter. Although the rate of appendiceal perforation tends to be higher in children, no pediatric-specific study has looked at the risk of rupture over time. We undertook this study to determine the relationship between the rate of perforation and the duration of symptoms in children with appendicitis.
Section snippets
Methods
We prospectively studied all children between the ages of 3 and 18 years who underwent open or laparoscopic appendectomy for suspected appendicitis from October 2006 through August 2008. All patients presented to a tertiary care children's hospital and level I trauma center. Data collected included age, sex, symptoms (abdominal pain, nausea, vomiting, diarrhea, or anorexia), heart rate, temperature, white blood cell count, and, if applicable, findings on imaging studies (ultrasound or computed
Results
A total of 202 consecutive patients aged 3 to 18 years who underwent an appendectomy from October 2006 through August 2008 were studied. Six patients were found at surgery or on pathology to have a normal appendix. These patients were excluded, leaving 197 patients for analysis. Table 1 summarizes patient demographic characteristics, symptoms, and clinical findings. There was no statistical difference in male-female ratio; however, children with perforated appendicitis were significantly
Discussion
Appendectomy is the most common emergency operation performed in children in the United States. Some have suggested that the perforation rate and morbidity in children with appendicitis are similar to those in adults [4], whereas others have reported far higher perforation rates in the pediatric age group [9], [10]. Two main factors can influence the rate of perforation in appendicitis. Very young age is typically associated with a higher rate of rupture [11], reaching 75% in children younger
References (22)
Appendicitis in pre-school children: a continuing clinical challenge. A retrospective study
Int J Surg
(2008)- et al.
How time affects the risk of rupture in appendicitis
J Am Coll Surg
(2006) - et al.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
J Clin Epidemiol
(2008) - et al.
An evidence-based definition for perforated appendicitis derived from a prospective randomized trial
J Pediatr Surg
(2008) - et al.
Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night?
J Pediatr Surg
(2004) - et al.
Selective use of ultrasonography for acute appendicitis in children
Am J Surg
(1999) - et al.
Laparoscopic appendectomy in children: report of 1,379 cases
J Pediatr Surg
(1994) - et al.
In-line image projection accelerates task performance in laparoscopic appendectomy
J Pediatr Surg
(2003) - et al.
A state-wide evaluation of appendectomy in children
Am J Surg
(1999) - et al.
National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data
Vital Health Stat.
(2007)
Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management
Ann Surg
Cited by (88)
Addressing health equity in pediatric surgical care in the United States– Progress and challenges
2023, Seminars in Pediatric SurgeryHigher Rates of Complicated Appendicitis During the COVID-19 Pandemic: A Year-to-Year Analysis
2023, Journal of Surgical ResearchThe intracorrelation of family health insurance and job lock
2023, Journal of Health EconomicsUnanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery
2023, Journal of Pediatric SurgeryNegative Appendectomies: Evaluating Diagnostic Imaging Techniques at General versus Pediatric Emergency Departments
2023, Journal of Emergency MedicineExpedited Surgical Care of Appendicitis is Associated With Improved Resource Utilization
2023, Journal of Surgical Research