Early Predictors of Abscess Development after Perforated Pediatric Appendicitis

Dickinson, Catherine M; Coppersmith, Nathan A; Luks, François I.

doi:10.1089/sur.2017.134

Cited by 12 publications

(9 citation statements)

References 16 publications

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“…Due to its high availability in almost all pediatric emergency departments, it should be considered a fundamental diagnostic tool. In children with a high clinical suspicion of PIAA, with symptoms such as diarrhea (8), fever and non-tolerating a regular diet (20), high values of NLR prior to surgery (as determined by our study) should encourage the performance of an imaging test as soon as possible.…”

Section: Discussionmentioning

confidence: 85%

Neutropthil-to-Lymphocyte Ratio as a Predictor of Postsurgical Intraabdominal Abscess in Children Operated for Acute Appendicitis

et al. 2019

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Aim of the study: Postoperative intra-abdominal abscess (PIAA) is a frequent and severe complication of acute appendicitis (AA) with peritonitis. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker that has been related to the development of peritonitis; however, its diagnostic role in predicting PIAA has not been evaluated. This is the first study that analyzes the usefulness of NLR as a predictor of PIAA in children operated for AA.Material and Methods: Retrospective observational study in children operated for AA in our institution during 2017–2018. Patients aged under 5 years or with incomplete laboratory determinations at hospital admission (blood count, C-reactive protein, and fibrinogen) were excluded. Demographic and laboratory parameters and the development of PIAA were analyzed. NLR was calculated by dividing the absolute number of neutrophils by the absolute number of lymphocytes. By means of ROC curves, we determined the sensitivity and specificity of the different laboratory parameters to predict the development of PIAA.Results: A total of 388 patients aged 10.5 ± 2.9 year were included. Twenty (5.2%) developed PIAA. NLR presented an area under the curve (AUC) of 0.85, significantly higher than the determination of leukocytes (AUC 0.69, p < 0.001), neutrophils (AUC 0.74, p < 0.001), fibrinogen (AUC 0.68, p < 0.001) and C-reactive protein (AUC 0.73, p < 0.001). We estimated the optimal cut-off point of NLR > 10.5, with a sensitivity of 85% and a specificity of 75.2%.Conclusions: NLR is the laboratory parameter with the highest sensitivity and specificity for predicting the development of PIAA in children operated for AA. It can be useful as a predictor of worse postoperative course.

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Section: Discussionmentioning

confidence: 85%

Neutropthil-to-Lymphocyte Ratio as a Predictor of Postsurgical Intraabdominal Abscess in Children Operated for Acute Appendicitis

et al. 2019

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“…Postoperative abscess is a main complication of perforated appendicitis and developed in approximately 12% of the patients with perforated appendicitis [23]. Postoperative antibiotic therapy can decrease the risk of abscess [24], and the optimal administration route is usually thought to be IV. In this meta-analysis, the result indicates that the IV/PO route is as effective as the IV route in terms of preventing an abscess.…”

Section: Discussionmentioning

confidence: 99%

Intravenous versus intravenous/oral antibiotics for perforated appendicitis in pediatric patients: a systematic review and meta-analysis

Wang

2019

BMC Pediatr

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BackgroundThe use of oral (PO) antibiotics following a course of certain intravenous (IV) antibiotics is proposed in order to avoid the complications of IV medications and to decrease the cost. However, the efficacy and safety of sequential IV/PO antibiotics is unclear and requires further study.MethodsThe databases, including PubMed, EMBASE and Cochrane Library, were searched. Studies comparing outcomes in patients with perforated appendicitis receiving sequential IV/PO and PO antibiotics therapy were screened. The Newcastle-Ottawa Scale (NOS) and the Jadad score were used to evaluate the quality of the cohort and the randomized controlled portions of the trial, respectively. Statistical heterogeneity was assessed using the I2 value. A fixed or random-effect model was applied according to the I2 value.ResultsFive controlled studies including a total of 580 patients were evaluated. The pooled estimates revealed that sequential IV/PO antibiotic therapy did not increase the risk of complications, with a risk ratio (RR) of 0.97 (95% CI 0.51–1.83, P = 0.93) for postoperative abscess, 1.04 (95% CI 0.25–4.36, P = 0.96) for wound infection and 0.62 (95% CI 0.33–1.16, P = 0.13) for readmission.ConclusionsOur study demonstrates that sequential IV/PO antibiotic therapy is noninferior to IV antibiotic therapy regarding postoperative abscess, wound infection and readmission.

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“…13 Our study supports the hypothesis that the return of intestinal function by the third postoperative day is an important indicator that an abscess will not form. 14 Some recommend that children can be safely discharged if diet is tolerated by the third postoperative day. Our study supports this recommendation.…”

Section: Discussionmentioning

confidence: 99%

“…Our study supports this recommendation. 14 Early laparoscopic appendectomy may arrest the progressive inflammation that delays intestinal function, and therefore promote early recovery. Because 40 per cent in the late group underwent appendectomy on the third day after pain onset, we recommend proceeding with appendectomy before the third day after pain onset when feasible.…”

Section: Discussionmentioning

confidence: 99%

Intestinal Function after Early versus Late Appendectomy in Children with Perforated Appendicitis

Munoz

Hazboun

Vannix

et al. 2019

The American Surgeon

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The aim was to prospectively document the impact of early versus late appendectomy on intestinal function in pediatric perforated appendicitis. After Institutional Review Board approval, between September 2016 and August 2017, complete data were prospectively collected for children undergoing planned appendectomy for perforated appendicitis. One hundred children with pathologist-confirmed transmural perforations were included. The median time to operation after pain onset was three days. Operation on day 1 or 2 (early) was compared with that on day 3 or after (late) (range, 3–9 days). Emesis, nasogastric tubes, and time to tolerate diet evaluated intestinal function. Categorical and continuous variables were analyzed by chi-square and t tests. Of the 100, there were 45 in the early and 55 in the late group, with 22/55(40%) operated on day 3. Children with early appendectomy were significantly younger, 7.8 (3.5) versus 9.5 (3.8) years (P = 0.02). Pre-appendectomy, more than 80 per cent of each group had emesis (P = 0.84), but the late group had a 10-fold increase in nasogastric tube use (P = 0.02). The early group tolerated regular diet significantly faster, 2.5 (2.1) versus 4.4 (4.1) days (P = 0.01), and had a significantly shorter hospital stay, 3.5 (2.2) versus 5.6 (4.3) days (P = 0.01). When pain onset to appendectomy is less than three days, the time to return of intestinal function is significantly reduced.

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Early Predictors of Abscess Development after Perforated Pediatric Appendicitis

Cited by 12 publications

References 16 publications

Neutropthil-to-Lymphocyte Ratio as a Predictor of Postsurgical Intraabdominal Abscess in Children Operated for Acute Appendicitis

Neutropthil-to-Lymphocyte Ratio as a Predictor of Postsurgical Intraabdominal Abscess in Children Operated for Acute Appendicitis

Intravenous versus intravenous/oral antibiotics for perforated appendicitis in pediatric patients: a systematic review and meta-analysis

Intestinal Function after Early versus Late Appendectomy in Children with Perforated Appendicitis

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