Image-guided abscess drainage in children with perforated appendicitis - can it wait?
Maria F Dien Esquivel1,2, Reza Belaghi3, Richard Webster3
1Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada. maridien@gmail.com.
Insights
For perforated appendicitis with abscess in children, delaying intervention (delta time) did not significantly impact outcomes like hospital stay or need for further procedures. Abscess size and number were more influential factors.
Area of Science:
- Pediatric Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Image-guided drainage is standard for perforated appendicitis with intra-abdominal abscesses.
- Optimal timing for intervention in pediatric cases remains unclear, lacking sufficient data.
Purpose of the Study:
- To evaluate the association between the time from diagnosis to drainage (delta time) and clinical outcomes in children with complicated appendicitis.
- To identify if delayed intervention impacts length of stay, catheter dwell time, or need for further procedures.
Main Methods:
- Retrospective study of 80 pediatric patients undergoing image-guided abscess drainage for perforated appendicitis.
- Analysis of delta time, abscess volume, and number of collections using gamma and logistic regression models.
- Outcomes assessed included length of stay, catheter dwell time, need for tissue plasminogen activator (t-PA), and additional interventions.
Main Results:
- Mean delta time was 1.5 days; no significant association was found between delta time and length of stay, catheter dwell time, need for t-PA, or additional interventions (P > 0.05).
- However, abscess volume and number of collections were significantly associated with longer length of stay, longer catheter dwell time, and increased need for additional interventions (P < 0.05).
Conclusions:
- The time interval between diagnosing an appendicitis-associated abscess and performing image-guided drainage does not appear to significantly affect key clinical outcomes in pediatric patients.
- Factors such as abscess volume and multiplicity are more critical predictors of clinical outcomes than the delay in intervention.
Background:
Image-guided drainage is the management of choice for perforated appendicitis with intra-abdominal abscess/es. However, there is paucity of data regarding the optimal time for intervention in children.
Objective:
The purpose of this study is to assess the relationship between the time from diagnosis of a drainable abscess to abscess drainage (delta time) and the clinical outcome in patients with complicated acute appendicitis.
Materials And Methods:
This is an institutional review board (IRB)-approved retrospective study comprising 80 pediatric patients who had image-guided abscess drainage due to perforated acute appendicitis. Delta time was associated with clinical outcome including length of stay, catheter dwell time, need for additional interventions, and need for tissue plasminogen activator (t-PA). Gamma regression models were used to assess the adjusted effect of delta time on the "length of stay" and "catheter dwell time" using "volume of the largest abscess" and "number of collections" as severity indices. Logistic regression was used to assess the effect of delta time on the "need for the t-PA" and "need for additional interventions."
Results:
Mean age (SD) was 10.2 (3.8) years. Mean time between diagnosis and intervention (delta time) was 1.5 (1.2) days. There was no evidence that delta time effects the length of stay, catheter dwell time, need for t-PA, and need for additional interventions (P > 0.05). However, there was an association between the number of collections and volume of the largest abscess with length of stay (P = 0.006; P = 0.058), catheter dwell time (P = 0.029; P < 0.001), and need for additional interventions (P = 0.029; P = 0.016).
Conclusions:
Our results suggest that time between diagnosis of an appendicitis associated abscess and intervention is not significantly associated with need for tPA, need for additional intervention, drain dwell time, or length of stay.
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