Factors contributing to the late diagnosis of appendicitis in children: the results of a retrospective study

Abstract

BACKGROUND: The diagnosis of acute appendicitis in children is often established late, which leads to complications, lethal outcomes are recorded.
 AIM: To identify and analyze the factors contributing to the late diagnosis of acute appendicitis in children.
 MATERIALS AND METHODS: A retrospective analysis of 279 case histories of children was carried out. The duration of symptoms is divided into time 1 (before hospitalization) and time 2 (from hospitalization to surgery). Patients were divided into two groups: 1st with destructive uncomplicated appendicitis (phlegmonous, gangrenous), 2nd with complicated appendicitis (unrestricted peritonitis, infiltrate, abscess). The causes of late hospitalization, symptoms indicated in the case histories, examinations performed, postoperative complications were analyzed. The diagnosis was established on the basis of intraoperative data, histological examination.
 RESULTS: In the 1st group, time 1 and time 2 were significantly less than in the 2nd (p 0.001; 0.028). Late presentation (24 hours) in 21.9%, misdiagnosis in 12.2% of cases. In the hospital, the observation of the patient 12 hours in 21.1% of patients. The frequency of presence / absence of a description of clinical and laboratory signs of acute appendicitis is from 100 to 19.7%. The 2nd group was characterized by: duration of symptoms 24 hours, repeated vomiting (p 0.001), febrile condition (p 0.001), increase in neutrophils 90% (8792%). Ultrasound examination with evaluation of the appendix in 20.1% of cases with a diagnostic accuracy of 89.3%. Laparoscopic appendectomy in 53.2% Alvarado scores are significantly higher in 2nd group (810) than in 1st group (79, p 0.001). In 1st group, complications were significantly less than 3.4% than in 2nd group 22.7 % (p 0.001).
 CONCLUSIONS: Factors contributing to the late diagnosis of appendicitis in children are: late treatment, diagnostic errors at the prehospital stage, incomplete clinical examination and observation, insufficient use of laboratory and instrumental methods.