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Overnight Decision-Making for Equivocal Appendicitis Often Involves Unnecessary Hospital Admissions.

Daniel R Liesman1, Steven T Papastefan1, Sara Ungerleider2

  • 1Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

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Summary
This summary is machine-generated.

Overnight observation for equivocal appendicitis in children leads to high negative appendectomy rates. Discharging low-risk patients may reduce hospital resource use without increasing missed diagnoses.

Keywords:
Alvarado scoreAppendectomyEquivocal appendicitisNegative appendectomy

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Area of Science:

  • Pediatric Surgery
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • After-hours consultations for equivocal appendicitis are frequent in pediatric hospitals.
  • Disposition options include admission with serial examinations (ASE) or discharge with return precautions.
  • Overnight ASE is exclusively utilized in our institution.

Purpose of the Study:

  • To characterize the benefits and harms of overnight ASE for equivocal appendicitis in pediatric patients.
  • To evaluate the outcomes of children with nondefinitive imaging for suspected appendicitis.

Main Methods:

  • Retrospective review of patients under 18 evaluated overnight for suspected appendicitis (July 2021-July 2023).
  • Equivocal appendicitis defined by nondefinitive imaging and surgical resident assessment.
  • Comparison of outcomes between ASE and discharged patient groups.

Main Results:

  • 43 patients (54%) were in the ASE group, 36 (46%) were discharged.
  • 10 ASE patients underwent appendectomy; 3 (30%) had negative appendectomies.
  • Discharged patients with low Alvarado scores rarely required subsequent intervention.

Conclusions:

  • Children with equivocal appendicitis presenting after-hours are often admitted despite low Alvarado scores.
  • Overnight ASE for equivocal appendicitis is associated with high negative appendectomy rates.
  • Discharging low Alvarado score patients may decrease resource utilization without increasing missed diagnoses.