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Effect of delay in presentation on rate of perforation in children with appendicitis

Chaitan K Narsule1, Eden J Kahle, Daniel S Kim

  • 1Division of Pediatric Surgery, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02905, USA.

The American Journal of Emergency Medicine
|July 15, 2010
PubMed

Insights

Pediatric appendicitis perforation risk increases with symptom duration, unlike in adults. Prehospital delays significantly contribute to perforation in children, highlighting the need for timely intervention.

Area of Science:

  • Pediatric Surgery
  • Emergency Medicine
  • Clinical Research

Background:

  • Appendicitis is the most frequent emergency surgical procedure in children.
  • The risk of appendiceal perforation may be linked to the time elapsed between symptom onset and surgical intervention.

Purpose of the Study:

  • To investigate the correlation between symptom duration and appendiceal perforation in a pediatric population.
  • To compare perforation risk factors in children with those observed in adult studies.

Main Methods:

  • A prospective study involving children over 3 years old who underwent appendectomy over a 22-month period.
  • Data collected included patient age, symptom duration, temperature, white blood cell count, and pre- and in-hospital delays.

Main Results:

  • Appendiceal perforation occurred in 10% of cases with symptom duration under 18 hours, rising linearly to 44% by 36 hours.
  • Younger children had a lower median age in the perforated group.
  • Prehospital delays were longer in patients with perforated appendicitis, while in-hospital delays were shorter.

Conclusions:

  • Appendiceal perforation in children is more prevalent than in adults and directly correlates with symptom duration.
  • The risk of perforation within 24 hours is substantial in children (7.7%) and increases linearly with time.
  • Prehospital delay is a more significant factor in pediatric appendiceal perforation than in-hospital delay.
Abstract

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