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Appendicitis in Children: Does Age Really Matter?
Kamal El Haissoufi1,2, El Hassan Hadi1,2, Salaheddine Habib1,2
1Department of Visceral and Urological Pediatric Surgery "A", Mohammed VI University Hospital, Oujda, Morocco.
Insights
Acute appendicitis in young children often presents atypically, with preschool children experiencing more severe symptoms and higher perforation rates. Early diagnosis of appendicitis in this age group remains challenging.
Area of Science:
- Pediatric Surgery
- Emergency Medicine
- Clinical Diagnostics
Background:
- Acute appendicitis (AA) is a common surgical emergency in children.
- AA presents unique diagnostic challenges in younger pediatric populations.
- Understanding age-related differences in AA presentation is crucial for timely intervention.
Purpose of the Study:
- To compare clinical presentation, diagnostic scores, and outcomes of acute appendicitis in preschool versus school-aged children.
- To identify factors contributing to diagnostic challenges in younger children with AA.
- To evaluate the utility of diagnostic scores (PAS and Alvarado) in differentiating appendicitis severity across age groups.
Main Methods:
- Retrospective review of 402 pediatric patients (<16 years) with confirmed AA.
- Division into two groups: Group A (preschool, ≤5 years) and Group B (school-aged, >5 years).
- Comparative analysis of clinical symptoms, biomarkers, diagnostic scores (Pediatric Appendicitis Score [PAS], Alvarado score), and intraoperative findings.
Main Results:
- Preschool children (Group A) exhibited higher rates of fever, bowel disturbances, diffuse abdominal pain, and tenderness (P < 0.001).
- Group A showed significantly elevated white blood cell counts and C-reactive protein levels (P < 0.003).
- Higher mean PAS and Alvarado scores were observed in Group A, with a greater proportion scoring ≥8 (P < 0.001), and significantly higher rates of appendiceal perforation (77.3% vs. 41.5%, P < 0.0001).
Conclusions:
- Acute appendicitis in preschool children is characterized by atypical presentations and rapid disease progression.
- Early diagnosis of AA in preschool children is significantly more challenging.
- The findings underscore the need for heightened clinical suspicion and potentially modified diagnostic approaches for AA in very young children.
Background:
Acute appendicitis (AA) is a frequent and emergent surgical abdominal condition that presents some particularities and challenges in young children.
Patients And Methods:
Data of 402 children aged <16 years with a confirmed diagnosis of AA were retrospectively reviewed. Included patients were divided into two groups: Group A (preschool children aged ≤5 years, n = 44) and Group B (school children aged >5 years, n = 358). Clinical presentation, biological findings, calculated diagnosis scores (paediatric appendicitis score [PAS] and Alvarado score), intraoperative findings and outcomes were comparatively analysed between the two groups.
Results:
Children of Group A had more likely fever, bowel disorders, diffuse abdominal pain and diffuse tenderness than those of Group B (P = 0.001, P = 0.005, P = 0.006 and P = 0.001, respectively). Regarding biomarkers, the mean of white blood cell count and C-reactive protein levels was higher in Group A than in Group B (18,849 cell/mm3 and 162.8 mg/L in Group A versus 15,938 cell/mm3 and 86.7 mg/L in Group B, P = 0.003 and < 0.001, respectively). The mean of calculated PAS and Alvarado scores was higher in Group A than in Group B (8.2 ± 1.1 and 8.2 ± 1 vs. 7.5 ± 1.4 and 7.4 ± 1.5, P = 0.003 and P = 0.001, respectively). Most children with a calculated PAS and Alvarado score equal to or higher than 8 belonged to Group A (PAS: 84.1% vs. 58.4%, P = 0.001, Alvarado score: 84.1% vs. 55.6%, P < 0.001). The perforation of the appendix was seen in 77.3% of Group A patients and only in 41.5% of children in Group B (P < 0.0001). The mean length of stay was 5.1 ± 1.9 days in Group A and 4.3 ± 2.8 days in Group B but without any statistical difference between the two groups (P = 0.094).
Conclusion:
AA in preschool children is associated with atypical presentation and rapid progression of the disease making the early diagnosis mostly challenging in our settings.
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