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The predictors of perforated appendicitis in the pediatric emergency department: A retrospective observational cohort

Zlatan Zvizdic1, Alisa Duric Golos2, Emir Milisic1

  • 1Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina.

The American Journal of Emergency Medicine
|June 24, 2021
PubMed

Insights

In children, male gender, vomiting, diarrhea, fever, elevated white blood cell count, and high C-reactive protein levels at emergency department admission predict perforated appendicitis (PA). These factors aid in distinguishing PA from non-perforated appendicitis (NPA).

Area of Science:

  • Pediatric Surgery
  • Emergency Medicine
  • Clinical Diagnostics

Background:

  • Appendiceal perforation (PA) significantly increases perioperative morbidity and impacts postoperative outcomes in children.
  • Early identification of PA in pediatric patients is crucial for timely intervention and improved patient management.

Purpose of the Study:

  • To identify predictive factors for perforated appendicitis (PA) in children upon emergency department (ED) admission.
  • To differentiate between PA and non-perforated appendicitis (NPA) in pediatric patients.

Main Methods:

  • Retrospective observational cohort study analyzing medical records of children (<18 years) with confirmed acute appendicitis (AA).
  • Patients were categorized into PA and non-perforated appendicitis (NPA) groups.
  • Univariate and multivariate analyses were employed to identify predictors of PA.

Main Results:

  • Out of 295 patients with AA, 92 (31.2%) had PA.
  • Univariate analysis identified male gender, vomiting, diarrhea, fever, elevated white blood cell count (WBC), and elevated C-reactive protein (CRP) as PA predictors.
  • Multivariate analysis confirmed male gender, vomiting, diarrhea, fever, elevated WBC, and elevated CRP as significant predictors of PA in children.

Conclusions:

  • Clinical and biochemical parameters at ED admission can reliably distinguish between pediatric PA and NPA.
  • Identifying these predictive factors can aid emergency physicians in the early diagnosis and management of perforated appendicitis in children.
Abstract

Keywords:
ChildrenPerforated appendicitisPredictive factors

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