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Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated
Jyotsna Bhattacharya1, Ellen J Silver2, Einat Blumfield3
1Pediatric Infectious Disease, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United States.
Insights
Children with complicated appendicitis face higher risks. Factors like abscess, free fluid in the right upper quadrant (RUQ FF), and elevated C-reactive protein (CRP) predict longer hospital stays and increased morbidity.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infectious Disease
Background:
- Appendicitis rupture in children significantly increases morbidity.
- Understanding factors predicting prolonged illness is crucial for pediatric care.
Purpose of the Study:
- To characterize the illness spectrum in children with complicated appendicitis.
- To identify factors associated with longer hospital stays in these patients.
Main Methods:
- Retrospective review of 132 children (≤18 years) with perforated appendix.
- Analysis of clinical, laboratory, and radiologic findings.
- Length of stay (LOS) dichotomized at the median (7 days).
Main Results:
- Longer LOS associated with increased morbidity (ICU stay, ileus, drainage procedures).
- Longer symptom duration predicted longer hospital stay.
- Abscess, RUQ FF on imaging, and CRP >12 independently predicted longer LOS.
Conclusions:
- Significant variation exists in complicated appendicitis morbidity.
- Abscess, RUQ FF, and elevated CRP are useful indicators for identifying children at risk for worse outcomes.
Objective:
In children with appendicitis, rupture of the appendix is associated with a significant increase in morbidity. We sought to characterize the spectrum of illness in children with complicated appendicitis and to define those factors associated with a longer hospital stay.
Study Design:
We conducted a retrospective review of 132 children, 18 years of age or younger at a large urban teaching hospital in the Bronx, NY between October 2015 and April 2018 with an intraoperative diagnosis of perforated appendix. Clinical, laboratory and radiologic findings were reviewed, and the primary study outcome was length of stay (LOS) dichotomized at the median, which was 7 days. Statistical analyses were done to characterize morbidity and define variables predictive of longer stay.
Results:
Children in the longer LOS group experienced significantly more morbidity, including ICU stay, ileus, and need for multiple drainage procedures. A longer duration of symptoms prior to presentation was associated with a longer stay. Multivariable logistic regression analysis indicated that the presence of abscess and presence of free fluid in the right upper quadrant (RUQ FF) on initial imaging and C-reactive protein (CRP) level >12 at admission, were independently associated with a longer stay.
Conclusion:
There is considerable variation in the morbidity of complicated appendicitis. The association between longer stay and the findings of abscess and RUQ FF on initial imaging along with an elevated CRP may provide a useful tool in identifying those children at risk for worse outcomes.
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