Related Experiment Videos
Acute appendicitis in young children in the Belfast urban area: 1985-1992
D Wilson1, S Sinclair, W A McCallion
1Royal Belfast Hospital For Sick Children.
Insights
Delays in seeking medical care and hospital referrals prolong symptoms in young children with acute appendicitis, increasing perforation risk. However, general practitioner diagnostic accuracy for preschool appendicitis is notably high.
Area of Science:
- Pediatrics
- Surgical Gastroenterology
Background:
- Acute appendicitis is a common surgical emergency in children.
- Appendiceal perforation in pediatric patients is associated with increased morbidity.
Purpose of the Study:
- To investigate the factors contributing to delays in the diagnosis and treatment of acute appendicitis in children under six years old.
- To determine the relationship between symptom duration, diagnostic delays, and appendiceal perforation in this age group.
Main Methods:
- Retrospective review of 81 cases of acute appendicitis in children under six years old in Belfast (1985-1992).
- Analysis of symptom duration, parental delay, general practitioner referral times, and in-hospital diagnostic delays.
- Correlation of these factors with the incidence of appendiceal perforation.
Main Results:
- Appendiceal perforation occurred in 43% of cases, significantly related to symptom duration.
- Parental delay in seeking medical advice (>36 hours) was the primary factor (52%), followed by delayed general practitioner referral (19%) and in-hospital diagnostic delay (>12 hours, 12%).
- In-hospital diagnostic delays were often unavoidable due to nonspecific symptoms and signs.
Conclusions:
- Prolonged symptom duration is a key factor in appendiceal perforation for young children.
- While parental and general practitioner delays contribute, the diagnostic accuracy of general practitioners for preschool appendicitis is high given its rarity.
- Strategies to reduce parental delay are crucial for improving outcomes in pediatric acute appendicitis.
Abstract:
Eighty-one cases of acute appendicitis in children aged less than six years were identified in the Belfast urban area between 1985 and 1992. Appendiceal perforation, found in 43%, was related to symptom duration but not to age at presentation. Prolongation of symptoms was related to parental delay in seeking medical advice (52% > 36 hours), delayed or inappropriate general practitioner referral to hospital (19%) and diagnostic delay following surgical consultation (12% > 12 hours). Diagnostic delay in hospital was usually the result of nonspecificity of symptoms and signs and was therefore largely unavoidable. Delayed referral from general practice did not contribute unnecessarily to appendiceal perforation, and given that an individual general practitioner will see a case of preschool appendicitis once in 30 years, diagnostic accuracy was remarkably high.