Diagnosing perforated appendicitis in pediatric patients: a new model

Bogaard, Veerle A B van den; Euser, Sjoerd M.; Ploeg, Tjeerd van der; Korte, Niels de; Sanders, D.G.M.; Winter, Derek de; Vergroesen, Diederik A.; Groningen, K. van; Winter, Peter de

doi:10.1016/j.jpedsurg.2015.10.054

Cited by 41 publications

(37 citation statements)

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“…Acute appendicitis is rare condition in children under 6 years of age and is often diagnosed with delay in this age group [1]. Indeed, an initial diagnostic error rate ranging from 28 to 57% is reported in children 12 years old or younger and can reach 100% in those 2 years of age or younger [2]. A recent study showed a significant increase of perforation in relation with age as follows: 100% < 1 year; 100% 1-2 years; 83,3% 2-3 years; 71,4% 3-4 years; 78,6% 4-5 years and 47,3% 5 years [3].…”

Section: Introductionmentioning

confidence: 99%

Influence of age on clinical presentation, diagnosis delay and outcome in pre-school children with acute appendicitis

Lounis¹,

Hugo²,

Demarche

et al. 2020

BMC Pediatr

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Background: Unusual clinical presentation of acute appendicitis in preschool children leads to misdiagnosis and complications. We aimed to analyze the influence of age on clinical presentation, laboratory findings and complications in preschool children with acute appendicitis. Methods: From January 2012 until December 2017, 29 children younger than 6 years of age (median 50 months) with acute appendicitis were enrolled in this retrospective study. Patients were grouped according to their age: group 1: < 48 months (n = 13); group 2: > 48 months (n = 16), their clinical data, laboratory results and complications were compared. Results: In group 1, duration of nausea and vomiting was longer, alteration of general state was more frequent and pain in the right fossa iliaca less frequent than in group 2 (p = 0.026, p = 0.000 and p = 0.029, respectively). Heart rate was higher in group 1 than in group 2 (p = 0.012). Leucocyte and polynuclear neutrophil counts were lower in group 1 than in group 2 (p = 0.028 and = 0.004, respectively) but C-reactive protein levels were not different between groups. In the whole cohort however, C-reactive protein at admission value correlated negatively with age (p = 0.025). Abdominal ultrasound allowed diagnosis in 19/29 patients (65.5%), without any difference between groups. Appendicular perforation was more frequent in group 1 than in group 2 (p = 0.003). Perforation was also related to longer hospital stay (p = 0.018). Peritonitis occurred in 21/29 (72%), post-operative ileus in 5/29 (17%) and sepsis in 4/29 (14%) patients without any difference between groups. In the whole cohort, hospital stay correlated negatively with age (p = 0.000). There was no mortality. Conclusions: Among preschool children, those younger than 48 months present with longer duration of preadmission symptoms indicating longer infection course than in older children. Altered general state and higher degree of tachycardia in the younger reflect higher systemic repercussions of the illness. Less specific abdominal pain and dissociation of the inflammatory markers with lower leucocyte-and neutrophil counts and higher Creactive protein levels in the younger may contribute to further diagnosis delay and higher rate of perforation in these patients.

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Section: Introductionmentioning

confidence: 99%

Influence of age on clinical presentation, diagnosis delay and outcome in pre-school children with acute appendicitis

Lounis¹,

Hugo²,

Demarche

et al. 2020

BMC Pediatr

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“…1 Approximately 25 to 38% are found to have perforated appendicitis. [2][3][4] Those with perforated appendicitis have higher morbidity rates especially higher rates of postoperative infection and longer hospital stays compared with those undergoing appendectomy for uncomplicated appendicitis. [4][5][6] Managing postoperative pain with perforated appendicitis can be a challenge.…”

Section: Introductionmentioning

confidence: 99%

Does Intravenous Acetaminophen Improve Postoperative Pain Control after Laparoscopic Appendectomy for Perforated Appendicitis? A Prospective Randomized Trial

et al. 2018

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“…정확한 원인은 알 수 없지만 분석, 림프양 증식증 등으로 인한 내강폐색이 원인이 되어 발생하며, 남자 및 10대 연령에서 가장 호발한다 [2]. 소아에서 급성충수염의 진단이 어려운 이유는 증상이 비특이적이며 환아가 통증에 대해 정확한 표현을 못하는 경우도 많고, 수술을 필요로 하지 않고 보존적으로도 치료가 되는 다른 질환도 급성충수염과 비슷한 증상을 나타내기 때문이다.…”

Section: 서 론unclassified

“…오진율은 문헌에 따라 6.9%에서 27.6%까지 보고하고 있다 [3][4][5]. 오진에 의해 급성 충수염 수술이 지연되면 충수의 천공이 발생하기 쉽고, 결국 복막염 및 복강 내 농양, 패혈증, 장 폐색 등의 합병증이 발생 하여 입원기간이 길어지며 그로 인한 의료비용의 상승이 일 어나고, 문헌에 따라서 3.5배에서 10배까지도 사망률이 증 가한다고 보고하고 있다 [2]. 오진율 및 천공률이 나이가 어 릴수록 빈도가 증가하여 1세 이하에서는 100%까지도 증가 한다 [2].…”

Section: 서 론unclassified

“…오진에 의해 급성 충수염 수술이 지연되면 충수의 천공이 발생하기 쉽고, 결국 복막염 및 복강 내 농양, 패혈증, 장 폐색 등의 합병증이 발생 하여 입원기간이 길어지며 그로 인한 의료비용의 상승이 일 어나고, 문헌에 따라서 3.5배에서 10배까지도 사망률이 증 가한다고 보고하고 있다 [2]. 오진율 및 천공률이 나이가 어 릴수록 빈도가 증가하여 1세 이하에서는 100%까지도 증가 한다 [2]. 따라서 급성충수염은 조기의 정확한 진단이 중요하 며, 주로 임상적 증상, 혈액검사 및 영상을 이용한 검사 등을 진단에 종합적으로 사용한다.…”

Section: 서 론unclassified

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Cause of Abdominal Ultrasound Diagnostic Errors in Children with Acute Appendicitis

Kim

Chung

2016

J Korean Assoc Pediatr Surg

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Purpose:The use of CT as a diagnostic tool in pediatric acute appendicitis is increasing because of its high sensitivity and specificity. However, due to both the serious concerns about radiation of CT and the convenience and reasonable cost of ultrasound (US) examination, US has value on the initial diagnosis of acute appendicitis despite of the lower sensitivity in children. The purpose of this study was to examine the factors that affect the rate of false negative diagnosis of the ultrasound from the patients who received laparoscopic appendectomy. Methods: The pediatric appendectomy cases from 2002 to 2013 in Yeouido St. Mary's Hospital have been reviewed through the medical records. We included patients who underwent an initial screening by ultrasound examination. Results: Among 181 patients, 156 patients were the sono-positive group and 25 patients were sono-negative group. There is no significant difference in ages, genders, physical examination findings and white blood cell count between the two groups. But, the degree of inflammation of appendicitis (simple, 58.3% vs. 32.0%; complicated, 41.7% vs. 68.0%) and the appendix position (antececal, 85.0% vs. 12.0%; retrocecal, 13.7% vs. 44.0%; pelvic, 1.3% vs. 44.0%) were significantly different between the two groups (sono-positive group vs. sono-negative group; p＜0.05). Conclusion:The position of the appendix may act as a factor that causes an error in the diagnostic ultrasound, especially, in the retrocecal type and the pelvic type with the higher risk of necrosis or perforation.

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Diagnosing perforated appendicitis in pediatric patients: a new model

Cited by 41 publications

References 39 publications

Influence of age on clinical presentation, diagnosis delay and outcome in pre-school children with acute appendicitis

Influence of age on clinical presentation, diagnosis delay and outcome in pre-school children with acute appendicitis

Does Intravenous Acetaminophen Improve Postoperative Pain Control after Laparoscopic Appendectomy for Perforated Appendicitis? A Prospective Randomized Trial

Cause of Abdominal Ultrasound Diagnostic Errors in Children with Acute Appendicitis

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