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Appendicitis in preschool aged children: Regression analysis of factors associated with perforation outcome
William Bonadio1, Peter Peloquin1, Jared Brazg1
1Maimonides Medical Center, Brooklyn NY.
Insights
Appendicitis perforation is common in young children, with risk increasing with symptom duration. Early diagnosis in preschool-aged children is crucial for better outcomes and reduced hospital stays.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Epidemiology
Background:
- Appendicitis in children under five is uncommon, representing 9% of pediatric cases.
- Perforation rates are high in this age group, particularly in infants.
Purpose of the Study:
- To identify clinical variables predicting perforation in preschool-aged children with appendicitis.
- To analyze the relationship between patient age, symptom duration, and perforation risk.
Main Methods:
- Retrospective review of 180 children under five diagnosed with appendicitis over eight years.
- Multivariate regression analysis to assess predictors of perforation outcome.
Main Results:
- Perforation rates decreased with age, from 100% in infants to 57% in four-year-olds.
- Symptom duration significantly increased perforation risk (93% >2 days).
- Appendicolith and symptom duration were the only significant predictors of perforation.
Conclusions:
- Appendicitis in young children often leads to delayed diagnosis and perforation.
- A high index of suspicion and prompt diagnosis are vital for improving outcomes.
- Symptom duration is a key factor in predicting perforation risk.
Objectives:
Apply multivariate regression analysis to determine the significance of clinical variables for perforation outcome of a large series of preschool aged children with appendicitis.
Methods:
Retrospective case review of 180 consecutive children<5 years of age diagnosed with appendicitis during an 8-year period.
Results:
This age group accounted for only 9% of all cases of pediatric appendicitis at our institution during the study period. Perforation rate was inversely proportional to patient age, occurring in 100% aged<1 year, 91% ages 1-2 years, 76% ages 2-3 years, 73% ages 3-4 years, and 57% ages 4-5 years. Risk for perforation increased proportionately with duration of symptoms, ranging from 48% when<1 day vs 84% when>1 day; and 93% when>2 days. One-quarter with perforation had a prior recent medical evaluation with an alternative diagnosis rendered preappendicitis diagnosis. The mean duration of hospitalization was four times longer in those with perforation [8 days] vs no perforation [2 days]. Univariate analysis showed each of the following factors was significantly associated with perforation outcome: younger patient age, female gender, prior medical visit<48 hours of appendicitis diagnosis, symptom duration, presence of fever, and presence of appendicolith. Multivariate logistic regression combining all significant univariate predictors showed only duration of symptoms and presence of appendicolith were significantly associated with perforation outcome; receiver-operating characteristic curves are generated to evaluate the predictive accuracy of these two factors, both individually and when combined.
Conclusions:
Although relatively uncommon in this age group, appendicitis is frequently associated with delayed diagnosis and perforation outcome. Risk for perforation is directly proportional to increasing duration of symptoms. Clinicians must maintain a high index of suspicion for this condition in these younger children, as early diagnosis is essential to maximizing outcome.
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