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Appendicitis in children: a continuing clinical challenge
R R Marrero1, S Barnwell, E L Hoover
1Department of Surgery, Meharry Medical College, Nashville, Tennessee.
Insights
Appendicitis presentation in children remained consistent over a decade. Perforation rates did not significantly decrease with age, and diagnosis-related groups (DRGs) slightly increased hospital stays.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Appendicitis is a common surgical emergency in children.
- Understanding presentation patterns and outcomes is crucial for timely diagnosis and treatment.
Purpose of the Study:
- To analyze trends in appendicitis presentation in pre-adolescent children over a 10-year period.
- To investigate the relationship between age and perforation incidence.
- To assess the impact of diagnosis-related groups (DRGs) on hospital length of stay.
Main Methods:
- Retrospective chart review of 42 children under 12 diagnosed with acute appendicitis between 1980-1989.
- Analysis of clinical presentation, laboratory findings, surgical outcomes, and length of stay.
- Comparison of pre- and post-DRG implementation data.
Main Results:
- Consistent presentation patterns including right lower quadrant pain, guarding, and positive diagnostic signs were observed.
- A significant perforation rate of 36% was found, with no clear decrease related to age.
- The average postoperative length of stay increased slightly after the implementation of DRGs.
Conclusions:
- Appendicitis presentation in children under 12 remained consistent over the study period.
- Age did not appear to be a significant factor in reducing perforation rates.
- Diagnosis-related groups (DRGs) may have contributed to a slight increase in hospital length of stay.
Abstract:
This article discusses the findings of a study of pre-adolescent children to determine if the mode of presentation of appendicitis had changed over the past 10 years, if the incidence of perforations decreased with age, and if diagnosis related groups (DRGs) impacted the length of hospital stay. The charts of 42 children under the age of 12 years who were discharged from two inner-city hospitals with a diagnosis of acute appendicitis from 1980 to 1989 were reviewed. There were 20 blacks and 22 whites, 26 males and 16 females with an average age of 7.31 years (range: 2 to 11 years). Over 95% of patients presented with right lower quadrant pain, 78% with guarding, 80% with a positive psoas sign, 93% with a positive Rovsing's sign, and 65% with rectal tenderness. Over 85% of patients had a history of nausea, vomiting, and anorexia. The mean duration of pain was 52.8 hours and the mean temperature was 99.6 degrees F. The mean white blood cell count was 18,176 +/- 4682 for whites versus 14,615 +/- 5459 for blacks. At surgery 15/42 (36%) of patients had a perforation, 11 of whom had positive wound cultures. Escherichia coli was recovered in all 11 of these patients. The average duration of pain in the perforated group was 50.9 hours, and the average age was 7 years. Eleven of these patients had normal bowel sounds on admission. Only 31% of the total cohort had a fecalith identified by pathology. The average postoperative length of stay was 6.5 +/- 2.5 days before the initiation of DRGs and 7.5 +/- 3 days afterward.