Acute Appendicitis in a Pediatric Minority Population: Uncommon Presentations of a Common Disease

Introduction Acute appendicitis (AA) is universally regarded as a leading cause of emergency surgery. Both a fiber-rich diet and socioeconomic status are suggested to affect the clinical and epidemiological properties of AA. The Arab minority, the largest ethnic minority in Israel, has unique dietary habits and socioeconomic characteristics, which may influence the presentation and outcomes of AA. Despite the known seasonal patterns of AA incidence, especially during summertime, variations within specific ethnic subpopulations remain underexplored. Methods We conducted a retrospective study focused on pediatric patients from the Arab minority in Israel. Clinical data were collected and analyzed from 401 pediatric patients with a primary diagnosis of AA. The collected variables included vital signs, laboratory workups (white blood cell (WBC) counts, C-reactive protein (CRP), and neutrophil percentages), and surgical reports. The analysis aimed to identify differences between simple and complicated AA cases within this subpopulation and compare the findings with reports from both Israel and worldwide. Results A total of 401 pediatric patients from the Arab minority with AA were analyzed. Male predominance was observed, with 62.5% (n = 251) of cases being males. Despite the commonly reported summertime peak for AA, our data showed no significant seasonal variability for both simple and complicated AA. Regarding clinical presentation, both sexes had similar blood pressure and body temperature at admission; however, females exhibited higher heart rates than males. Notably, over 90% of patients presented without fever, having body temperatures below 38°C, even in complicated cases. Laboratory findings revealed differences between simple and complicated AA. In simple AA, WBC and CRP levels were mildly elevated (WBC 13.4 ± 4.5 × 10³/mm³, CRP 3.3 ± 5.4 mg/dL). In contrast, complicated AA cases showed significantly elevated heart rates, WBC, neutrophil percentages, and CRP levels. Among biomarkers, WBC <10⁴ cells/mm³ effectively ruled out complicated AA (negative predictive value (NPV) 98.7%, sensitivity 98%), while CRP >5 mg/dL had the highest specificity (81%) but lower sensitivity (54%) and limited predictive value (NPV 92%). The complicated AA rate was 12.7%, which is lower than previously reported in regional and global studies. Additionally, 18.5% (n = 74) of patients received non-operative management (NOM), a higher rate than typically reported locally. Conclusions This study highlights key clinical patterns and diagnostic insights among AA patients from a pediatric minority population. Arab children demonstrate male predominance, consistent AA rates across seasons, and are less likely to present with fever or complicated AA compared to other populations. Furthermore, WBC and CRP emerge as useful tools for ruling out complicated AA, despite their limited predictive value for confirming it. Notably, the low complicated AA rates and higher NOM rates (18.5%) may reflect unique dietary habits and healthcare accessibility patterns within this minority group. Our findings contribute to a more nuanced understanding of AA presentation in diverse populations and underscore the importance of tailored clinical assessments for minority subpopulations.