Acute appendicitis: is there a difference between children and adults?

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Emergency Medicine

Background:

• Acute appendicitis diagnosis is challenging in children due to atypical symptoms and delayed presentation, historically leading to higher perforation rates.
• Despite challenges, pediatric appendicitis generally has lower morbidity compared to adults.

Purpose of the Study:

• To compare clinical presentation, diagnostic indicators, and outcomes of acute appendicitis in pediatric versus adult patients.
• To evaluate if delayed presentation impacts perforation rates in children.

Main Methods:

• Retrospective review of 210 pediatric (≤13 years) and 744 adult appendectomy cases (January 1995-December 2000).
• Comparison of presentation duration, prior evaluations, imaging use (CT/ultrasound), emergency room evaluation time, and observed cases.
• Analysis of diagnostic clues including classic migratory pain and white blood cell (WBC) count.

Main Results:

• Pediatric patients had similar pain duration and imaging use but shorter emergency room evaluation times compared to adults.
• Classic migratory pain (94.2% vs 89.6%) and elevated WBC count (> or =12 x 10^9/L) (91.5% vs 84.3%) were highly predictive in both groups.
• Negative appendectomy rates were lower in children (10.0% vs 19.0%), while perforation rates were similar (19.0% vs 13.8%).
• Pediatric perforation was not linked to delayed presentation; mortality and morbidity were comparable between age groups.

Conclusions:

• Contrary to traditional beliefs, acute appendicitis diagnosis and presentation are similar in children and adults.
• Migratory pain, physical findings, and leukocytosis are reliable diagnostic markers for appendicitis in both pediatric and adult populations.
• Appendicitis outcomes, including perforation and morbidity, are comparable between children and adults, irrespective of presentation delay.