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Effects of Timing to Diagnosis and Appendectomy in Pediatric Appendicitis

Katherine Mandeville1, Michael Monuteaux, Tamara Pottker

  • 1From the *Department of Emergency Medicine, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM; †Division of Emergency Medicine, Children's Hospital Boston, Boston, MA; and ‡Department of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ.

Pediatric Emergency Care
|November 5, 2015
PubMed

Insights

Pediatric appendicitis patients with symptoms over 48 hours face significantly higher perforation risks and longer hospital stays. Timely surgery after diagnosis did not impact outcomes, but prolonged symptoms are critical for appendicitis severity.

Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Clinical outcomes research

Background:

  • Appendicitis is a common surgical emergency in children.
  • Understanding factors influencing appendicitis outcomes, such as symptom duration and surgical timing, is crucial for patient management.
  • Appendiceal perforation is a significant complication associated with delayed treatment.

Purpose of the Study:

  • To prospectively evaluate pediatric appendicitis patients.
  • To assess the relationship between duration of symptoms and appendectomy timing on perforation rates.
  • To determine the impact on hospital length of stay (LOS) and operating room (OR) times.

Main Methods:

  • Data collected on symptom duration to diagnosis and diagnosis to appendectomy.
  • Symptomatology duration analyzed in 24-hour increments; diagnosis to appendectomy in 3-hour intervals.
  • Appendiceal perforation rates, hospital LOS, and OR times were key outcome measures.

Main Results:

  • Analysis of 230 pediatric patients revealed 28% had perforated appendicitis.
  • Perforations were associated with longer OR times and significantly increased hospital LOS.
  • Symptomatology exceeding 48 hours correlated with a 4.9-fold increased odds of perforation and 55.7% greater hospital LOS.

Conclusions:

  • Pediatric appendicitis patients with symptoms >48 hours have substantially higher perforation odds and LOS.
  • No significant difference in perforation rates or LOS was found based on timing of surgery post-diagnosis.
  • Emergency department LOS before surgery did not demonstrate an effect on perforation rates.
Abstract

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