Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Risk factors of delayed diagnosis of acute appendicitis in children: for early detection of acute appendicitis

  • Choi, Jea Yeon (Department of Emergency Medicine, Gachon University Gil Medical Center) ;
  • Ryoo, Eell (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Jo, Jeong Hyun (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Hann, Tchah (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Kim, Seong Min (Department of General Surgery, Gachon University Gil Medical Center)
  • Received : 2016.05.10
  • Accepted : 2016.08.12
  • Published : 2016.09.10
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study examined the risk factors of a delayed diagnosis of acute appendicitis in children undergoing an appendectomy. Methods: This retrospective study involved children aged below 18 years, who underwent an appendectomy. After dividing them into a delayed diagnosis group and nondelayed diagnosis group according to the time interval between the initial hospital visit and final diagnosis, the risk factors of delayed diagnosis were identified using logistic regression analysis. Results: Among 712 patients, 105 patients (14.7%) were classified in the delayed diagnosis group; 92 patients (12.9%) were diagnosed using ultrasonography (US), and both US and computed tomography were performed in 38 patients (5.3%). More patients in the delayed diagnosis group underwent US (P=0.03). Spring season and prior local clinic visit were significantly associated with a delayed diagnosis. Fever and diarrhea were more common in the delayed diagnosis group (fever: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.05-1.81; diarrhea: OR, 1.94; 95% CI, 1.08-3.46; P<0.05). These patients showed symptoms for a longer duration (OR, 2.59; 95% CI, 1.78-3.78; P<0.05), and the admission course (OR, 1.26; 95% CI, 1.11-1.44; P<0.05) and C-reactive protein (CRP) levels (OR, 1.47; 95% CI, 1.19-1.82; P<0.05) were associated with the delayed diagnosis. Conclusion: To decrease the rate of delayed diagnoses of acute appendicitis, symptoms such as fever and diarrhea, seasonal variations, admission course, and CRP levels should be considered and children with a longer duration of symptoms should be closely monitored.

Keywords

References

  1. Pittman-Waller VA, Myers JG, Stewart RM, Dent DL, Page CP, Gray GA, et al. Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg 2000;66:548-54.
  2. Erdem H, Cetinkunar S, Das K, Reyhan E, Deger C, Aziret M, et al. Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis. World J Gastroenterol 2013;19:9057-62. https://doi.org/10.3748/wjg.v19.i47.9057
  3. Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 2000; 36:39-51. https://doi.org/10.1067/mem.2000.105658
  4. Rothrock SG, Skeoch G, Rush JJ, Johnson NE. Clinical features of misdiagnosed appendicitis in children. Ann Emerg Med 1991;20: 45-50.
  5. Curran TJ, Muenchow SK. The treatment of complicated appendicitis in children using peritoneal drainage: results from a public hospital. J Pediatr Surg 1993;28:204-8. https://doi.org/10.1016/S0022-3468(05)80276-3
  6. Graff L, Russell J, Seashore J, Tate J, Elwell A, Prete M, et al. False-negative and false-positive errors in abdominal pain evaluation: failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med 2000;7:1244-55. https://doi.org/10.1111/j.1553-2712.2000.tb00470.x
  7. Reynolds SL. Missed appendicitis in a pediatric emergency department. Pediatr Emerg Care 1993;9:1-3. https://doi.org/10.1097/00006565-199302000-00002
  8. Barker AP, Davey RB. Appendicitis in the first three years of life. Aust N Z J Surg 1988;58:491-4. https://doi.org/10.1111/j.1445-2197.1988.tb06241.x
  9. Williams N, Kapila L. Acute appendicitis in the under-5 year old. J R Coll Surg Edinb 1994;39:168-70.
  10. O'Toole SJ, Karamanoukian HL, Allen JE, Caty MG, O'Toole D, Azizkhan RG, et al. Insurance-related differences in the presentation of pediatric appendicitis. J Pediatr Surg 1996;31:1032-4. https://doi.org/10.1016/S0022-3468(96)90079-2
  11. Golladay ES, Sarrett JR. Delayed diagnosis in pediatric appendicitis. South Med J 1988;81:38-42. https://doi.org/10.1097/00007611-198801000-00008
  12. Buchman TG, Zuidema GD. Reasons for delay of the diagnosis of acute appendicitis. Surg Gynecol Obstet 1984;158:260-6.
  13. Cappendijk VC, Hazebroek FW. The impact of diagnostic delay on the course of acute appendicitis. Arch Dis Child 2000;83:64-6. https://doi.org/10.1136/adc.83.1.64
  14. Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002;37: 877-81. https://doi.org/10.1053/jpsu.2002.32893
  15. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132:910-25. https://doi.org/10.1093/oxfordjournals.aje.a115734
  16. Von Titte SN, McCabe CJ, Ottinger LW. Delayed appendectomy for appendicitis: causes and consequences. Am J Emerg Med 1996;14: 620-2. https://doi.org/10.1016/S0735-6757(96)90074-1
  17. Harrison MW, Lindner DJ, Campbell JR, Campbell TJ. Acute appendicitis in children: factors affecting morbidity. Am J Surg 1984;147:605-10. https://doi.org/10.1016/0002-9610(84)90123-5
  18. Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg 2006;202:401-6. https://doi.org/10.1016/j.jamcollsurg.2005.11.016
  19. Gamal R, Moore TC. Appendicitis in children aged 13 years and younger. Am J Surg 1990;159:589-92. https://doi.org/10.1016/S0002-9610(06)80073-5
  20. Eriksson S, Granstrom L, Carlstrom A. The diagnostic value of repetitive preoperative analyses of C-reactive protein and total leucocyte count in patients with suspected acute appendicitis. Scand J Gastroenterol 1994;29:1145-9. https://doi.org/10.3109/00365529409094902
  21. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 2004;91:28-37. https://doi.org/10.1002/bjs.4464

Cited by

  1. Acute Appendicitis in Young Children: A Persistent Diagnostic Challenge for Clinicians vol.10, pp.3, 2016, https://doi.org/10.7759/cureus.2347
  2. 소아 청소년의 급성 충수염: 천공과 연관된 인자 및 원인균 vol.25, pp.1, 2016, https://doi.org/10.14776/piv.2018.25.1.1
  3. Discovery of Urinary Proteomic Signature for Differential Diagnosis of Acute Appendicitis vol.2020, pp.None, 2020, https://doi.org/10.1155/2020/3896263