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

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.