Pediatric appendicitis or not: A retrospective cohort study from a single institution-our management and factors determining the disease

Authors

  • Nimmita Srisan Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai red cross society, Bangkok, Thailand
  • Teerasak PhewPlung Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai red cross society, Bangkok, Thailand
  • Katawaetee Decharun Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai red cross society, Bangkok, Thailand
  • Prapapan Rajatapiti Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai red cross society, Bangkok, Thailand
  • Paisarn Vejchapipat Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai red cross society, Bangkok, Thailand

Keywords:

Appendicitis, computed tomography, diagnosis, overnight observation, ultrasonography

Abstract

Background: Appendicitis in children is a common health problem, but its management still has some controversial aspects.

Objectives: This study aimed to assess our treatment guidelines and determine factors in differentiating children with acute appendicitis from other diseases.

Methods: Pediatric surgery consultations for suspected appendicitis from October 2019 to October 2021 was retrospectively studied. The treatment guidelines of children with suspected appendicitis were elucidated. Moreover, factors identifying the diagnosis of appendicitis were analyzed using multi-variate logistic regression.

Results: Ninety-one children were consulted for suspected appendicitis. Forty-one children (45.1%) were promptly successfully treated without observation or ultrasonography, except one negative appendectomy (2.4%). The other 50 children (54.9%), showed equivocal clinical symptoms and signs, requiring further management either overnight observation (11 cases) or ultrasonography (39 cases). Following observation, 7 patients (63.6%) were successfully treated without further imaging studies. On the contrary, after abdominal ultrasound (39 cases), appendices or other intra-abdominal pathologies could be demonstrated, leading to definitive diagnosis and treatment in 17 patients (43.6%), except one false-positive case (5.9%). Only 6 patients had computed tomography (CT) scintigraphy following equivocal ultrasound findings. Accordingly, the treatment guidelines achieved an overall 93.4% accuracy. Clinical complaints were statistically different as majority of cases with appendicitis having migratory pain (46.3%, P < 0.001). With logistic regression analysis, it was revealed that migratory pain, right lower quadrant (RLQ) tenderness, elevated white blood cell (WBC) count and high proportion of neutrophils were significantly associated with appendicitis.

Conclusion: Pediatric appendicitis is occasionally arduous to diagnose. By minimizing the utilization of CT scan, our treatment guidelines accomplish high accuracy. Careful history taking, thorough physical examination, and basic laboratories were crucial for accurate diagnosis.

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Published

2024-01-25

How to Cite

1.
Srisan N, PhewPlung T, Decharun K, Rajatapiti P, Vejchapipat P. Pediatric appendicitis or not: A retrospective cohort study from a single institution-our management and factors determining the disease. Chula Med J [Internet]. 2024 Jan. 25 [cited 2024 Nov. 11];68(1). Available from: https://he05.tci-thaijo.org/index.php/CMJ/article/view/1237