Active observation of children with possible appendicitis does not increase morbidity
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Published on: August 24, 2019
1Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Insights
Active observation for suspected appendicitis in children is effective, with a 93% diagnostic accuracy. This approach does not lead to significant delays or high postoperative complications, even in cases of perforation.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Clinical Outcomes
Background:
- Hospital observation is used for children with suspected appendicitis and unclear physical signs to improve diagnosis and reduce surgery.
- Perforation-related morbidity underscores the need for prompt appendicitis management and raises concerns about prolonged preoperative observation.
Purpose of the Study:
- To evaluate preoperative delay and complications linked to active observation for appendicitis in children.
- To determine the impact of observation on diagnostic accuracy and patient outcomes.
Main Methods:
- Retrospective review of 378 children undergoing appendectomy over 4 years.
- Analysis of preoperative hospital stay duration and complication rates.
Main Results:
- Active observation achieved 93% diagnostic accuracy with a mean preoperative hospital stay of 12 hours.
- The incidence of gangrene or perforation was 32%, with a mean preoperative stay of 7 hours in this subgroup.
- Overall postoperative infective complications were 4%, rising to 12% following perforation.
Conclusions:
- Children with advanced appendicitis typically present with clear signs, avoiding prolonged observation.
- Active observation is not associated with increased postoperative morbidity in pediatric appendicitis cases.
Background:
Attempts to maximise diagnostic accuracy and reduce unnecessary surgery have led to the hospital observation of children with suspected appendicitis but unconvincing physical signs. However, morbidity associated with perforation necessitates the prompt management of acute appendicitis and increases anxiety concerning prolonged preoperative observation.
Methods:
To assess the preoperative delay and subsequent complications associated with active observation of appendicitis, we reviewed the records of 378 children who had an appendicectomy performed at the Women's and Children's Hospital during a 4-year period.
Results:
Active observation was associated with an overall diagnostic accuracy of 93%. The mean preoperative hospital time was 12 h. The incidence of gangrene or perforation was 32%, with a mean preoperative hospital time in this group of 7 h. In view of the short preoperative waiting time in this group, we do not believe perforation in hospital to have been a frequent occurrence. The overall incidence of postoperative infective complications was 4%, with an incidence of 12% following perforation.
Conclusions:
Children with advanced disease often have convincing signs on presentation and are not usually subjected to a significant delay. Active observation is not associated with high postoperative morbidity.
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