Predictors of a Prolonged Length of Stay in Children with Perforated Appendicitis

Pathak, Indu; Sayed, Imran; Wise, Laura; Sippel, Michael; Hernandez, Loretta L; Mulla, Zuber D.

doi:10.14423/smj.0000000000000438

Cited by 4 publications

(1 citation statement)

References 1 publication

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“…The only demographic feature associated with LOS was race, with Black children were more likely to have a longer LOS compared to Hispanic/Latino children. These findings are consistent with a retrospective study by Pathak et al, who also found a lower risk for prolonged LOS in Hispanic children with perforated appendix ( 17 ). The reasons for these differences are not clear.…”

Section: Discussionsupporting

confidence: 92%

Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis

et al. 2022

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ObjectiveIn children with appendicitis, rupture of the appendix is associated with a significant increase in morbidity. We sought to characterize the spectrum of illness in children with complicated appendicitis and to define those factors associated with a longer hospital stay.Study DesignWe conducted a retrospective review of 132 children, 18 years of age or younger at a large urban teaching hospital in the Bronx, NY between October 2015 and April 2018 with an intraoperative diagnosis of perforated appendix. Clinical, laboratory and radiologic findings were reviewed, and the primary study outcome was length of stay (LOS) dichotomized at the median, which was 7 days. Statistical analyses were done to characterize morbidity and define variables predictive of longer stay.ResultsChildren in the longer LOS group experienced significantly more morbidity, including ICU stay, ileus, and need for multiple drainage procedures. A longer duration of symptoms prior to presentation was associated with a longer stay. Multivariable logistic regression analysis indicated that the presence of abscess and presence of free fluid in the right upper quadrant (RUQ FF) on initial imaging and C-reactive protein (CRP) level >12 at admission, were independently associated with a longer stay.ConclusionThere is considerable variation in the morbidity of complicated appendicitis. The association between longer stay and the findings of abscess and RUQ FF on initial imaging along with an elevated CRP may provide a useful tool in identifying those children at risk for worse outcomes.

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Section: Discussionsupporting

confidence: 92%

Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis

et al. 2022

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Using shock index, pediatric age adjusted (SIPA) to predict prolonged length of stay in perforated appendicitis: a retrospective review

Barone-Camp,

Louiselle,

Bothwell

et al. 2024

Pediatr Surg Int

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Using shock index, pediatric age adjusted (SIPA) to predict prolonged length of stay in perforated appendicitis

Barone-Camp,

Louiselle,

Bothwell

et al. 2024

Preprint

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Purpose Hospital length of stay (LOS) following admission for appendicitis is difficult to predict. Shock index, pediatric age adjusted (SIPA) accurately identifies severely injured trauma patients and predicts mortality among children admitted to the ICU. Our aim was to determine if elevated SIPA at presentation, and time to normalization of SIPA, can identify children with perforated appendicitis and predict hospital LOS. Methods This was a retrospective cohort study of children 1–17 years admitted to a quaternary care referral center with appendicitis after appendectomy in 2021. The primary outcomes were presence of perforated appendicitis and hospital LOS. Generalized linear regressions were performed. Covariates included in all models were age, sex, fecalith, initial temperature, and time from diagnosis to OR. Results We included 169 patients; 53 (31.4%) had perforated appendicitis. After adjustment, elevated SIPA was associated with presence of perforated appendicitis (p = 0.0002) and longer LOS (p < 0.0001). A patient presenting with appendicitis and elevated SIPA had 5.447 times higher odds of having perforated appendicitis (95% CI: 2.262, 13.826), a mean hospital LOS 2.047 times longer (95% CI: 1.564, 2.683), a mean time to toleration of regular diet 4.995 times longer (95% CI: 2.914, 8.918), and a mean duration of antibiotics that is 1.761 times longer (95% CI: 1.383, 2.243) than a patient with normal SIPA. Conclusion In children with appendicitis, elevated SIPA at presentation is associated with higher risk of perforation. These findings support the incorporation of SIPA during triage of patients with appendicitis and counseling families after surgery.

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Predictors of a Prolonged Length of Stay in Children with Perforated Appendicitis

Abstract: Hispanic ethnicity was associated with a lower odds of PLOS, whereas children who required the services of an interventional radiologist were more likely to experience PLOS.

Cited by 4 publications

References 1 publication

Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis

Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis

Using shock index, pediatric age adjusted (SIPA) to predict prolonged length of stay in perforated appendicitis: a retrospective review

Using shock index, pediatric age adjusted (SIPA) to predict prolonged length of stay in perforated appendicitis

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