Factors predictive of complicated appendicitis in children

Pham, Xuan-Binh D.; Sullins, Veronica F.; Kim, Dennis Y.; Range, Blake; Kaji, Amy H.; Virgilio, Christian M. de; Lee, Steven L.

doi:10.1016/j.jss.2016.07.023

Cited by 78 publications

(137 citation statements)

References 11 publications

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“…The findings of this study are consistent with our pilot data observations and also with the sparse previous retrospective data on plasma sodium concentration as a marker in children 17 and adults 18,19 in this context. A recent metaanalysis found the pooled sensitivity and specificity to differentiate complicated (perforated or gangrenous appendicitis) from noncomplicated AA to be within the range of 0.14 to 0.59 and 0.74 to 1, respectively, when nine different CT features informative for complicated AA were studied.…”

Section: Discussionsupporting

confidence: 93%

Low Plasma Sodium Concentration Predicts Perforated Acute Appendicitis in Children: A Prospective Diagnostic Accuracy Study

et al. 2019

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Background Early differentiation between perforated and nonperforated acute appendicitis (AA) in children is of major benefit for the selection of proper treatment. Based on pilot study data, we hypothesized that plasma sodium concentration at hospital admission is a diagnostic marker for perforation in children with AA. Materials and Methods This was a prospective diagnostic accuracy study, including previously healthy children, 1 to 14 years of age, with AA. Blood sampling included plasma sodium concentration, plasma glucose, base excess, white blood cell count, plasma arginine vasopressin (AVP), and C-reactive protein. Results Eighty children with histopathologically confirmed AA were included in the study. Median plasma sodium concentration on admission in patients with perforated AA (134 mmol/L, [interquartile range 132–136]) was significantly lower than in children with nonperforated AA (139 mmol/L, [137–140]). The receiver operating characteristic curve of plasma sodium concentration identifying patients with perforated AA showed an area under the curve of 0.93 (95% confidence interval, 0.87–0.99), with a sensitivity and specificity of 0.82 (0.70–0.90) and 0.87 (0.60–0.98), respectively. Plasma sodium concentrations ≤136 mmol/L resulted in an odds ratio of 31.9 (6.3–161.9) for perforation. The association between low plasma sodium concentration and perforated AA was confirmed in a multivariate logistic regression analysis. Median plasma AVP on admission was higher in patients with perforated (8.6 pg/mL [5.0–14.6]) as compared with nonperforated AA (3.4 pg/mL [2.5–6.6]). Conclusion In children with AA, there is a strong association between low plasma sodium concentration and perforation, a novel and not previously described finding.

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Section: Discussionsupporting

confidence: 93%

Low Plasma Sodium Concentration Predicts Perforated Acute Appendicitis in Children: A Prospective Diagnostic Accuracy Study

et al. 2019

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“…Previous studies have shown that complications due to appendicitis are more frequent and more severe in children than in adults. Furthermore, patients with complicated appendicitis are more likely to be under 5 years of age and to have had symptoms for a period exceeding 24 h, compared to patients with uncomplicated appendicitis [18]. Our results are consistent with that.…”

Section: Discussionsupporting

confidence: 91%

Influence of age on clinical presentation, diagnosis delay and outcome in pre-school children with acute appendicitis

Lounis¹,

Hugo²,

Demarche

et al. 2020

BMC Pediatr

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Background: Unusual clinical presentation of acute appendicitis in preschool children leads to misdiagnosis and complications. We aimed to analyze the influence of age on clinical presentation, laboratory findings and complications in preschool children with acute appendicitis. Methods: From January 2012 until December 2017, 29 children younger than 6 years of age (median 50 months) with acute appendicitis were enrolled in this retrospective study. Patients were grouped according to their age: group 1: < 48 months (n = 13); group 2: > 48 months (n = 16), their clinical data, laboratory results and complications were compared. Results: In group 1, duration of nausea and vomiting was longer, alteration of general state was more frequent and pain in the right fossa iliaca less frequent than in group 2 (p = 0.026, p = 0.000 and p = 0.029, respectively). Heart rate was higher in group 1 than in group 2 (p = 0.012). Leucocyte and polynuclear neutrophil counts were lower in group 1 than in group 2 (p = 0.028 and = 0.004, respectively) but C-reactive protein levels were not different between groups. In the whole cohort however, C-reactive protein at admission value correlated negatively with age (p = 0.025). Abdominal ultrasound allowed diagnosis in 19/29 patients (65.5%), without any difference between groups. Appendicular perforation was more frequent in group 1 than in group 2 (p = 0.003). Perforation was also related to longer hospital stay (p = 0.018). Peritonitis occurred in 21/29 (72%), post-operative ileus in 5/29 (17%) and sepsis in 4/29 (14%) patients without any difference between groups. In the whole cohort, hospital stay correlated negatively with age (p = 0.000). There was no mortality. Conclusions: Among preschool children, those younger than 48 months present with longer duration of preadmission symptoms indicating longer infection course than in older children. Altered general state and higher degree of tachycardia in the younger reflect higher systemic repercussions of the illness. Less specific abdominal pain and dissociation of the inflammatory markers with lower leucocyte-and neutrophil counts and higher Creactive protein levels in the younger may contribute to further diagnosis delay and higher rate of perforation in these patients.

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“…There are studies reporting different results and cut-off values on the diagnostic value of inflammatory markers, such as blood leukocyte and neutrophil counts and serum CRP levels in differentiating perforated appendicitis from simple appendicitis in children [3,4,[11][12][13][14] . Williams et al [3] reported that a leukocyte count >19.400/mm 3 in patients with acute appendicitis is an independent marker for perforated appendicitis, whereas Pham et al [11] reported this number to be >12.000/mm 3 . On the other hand, Lin et al [15] reported no diagnostic value of leukocytosis and neutrophilia in determining the risk of perforation in pediatric patients with acute appendicitis.…”

Section: Discussionmentioning

confidence: 99%

“…However, data on the relationship between perforated appendicitis and hyponatremia are very limited in pediatric patients. In a single study evaluating the association between hyponatremia and complicated appendicitis in children, it was found that the risk of complicated appendicitis increased 3-fold in patients with hyponatremia, and that hyponatremia (serum Na ≤135 mEq/L) was an independent predictor for complicated appendicitis [11] . In our study, which hypothesized that the detection of hyponatremia during the initial admission to the emergency room was a predictive finding for complicated appendicitis, no relationship was found between hyponatremia and complicated appendicitis, in contrast with what was expected.…”

Section: Discussionmentioning

confidence: 99%

“…There are several studies on the diagnostic value of laboratory tests performed to differentiate perforated appendicitis from simple appendicitis. Leukocyte count, neutrophil count, serum C-reactive protein (CRP) level, and sedimentation rate are among the most investigated parameters in these studies [3,4,[11][12][13][14] . In the literature, data on the relationship between perforated appendicitis and hyponatremia are very limited in pediatric patients.…”

Section: Original Articlementioning

confidence: 99%

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Predictive value of serum sodium level in determining complicated appendicitis risk in children

Besli¹

2019

Haydarpasa Numune Med J

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Introduction: Acute appendicitis is one of the most common surgical emergencies in childhood. Early recognition and treatment of children with complicated appendicitis, especially perforated and gangrenous, is very crucial. The aim of the present study was to determine the predictive value of simple blood tests, such as serum sodium (Na) level, C-reactive protein (CRP) level, and blood leukocyte and neutrophil counts, in complicated appendicitis. Methods: A total of 403 patients who underwent operation with the initial diagnosis of acute appendicitis that was confirmed by surgery and histopathology were evaluated retrospectively. Patients with perforated or gangrenous appendix, generalized peritonitis, and intra-abdominal abscess were identified as complicated appendicitis. Basal serum Na and CRP levels and blood leukocyte and neutrophil counts of patients with complicated and non-complicated appendicitis were compared. Results: Of the 403 patients, 158 (39.2%) had non-complicated, and 245 (60.8%) had complicated appendicitis. No difference was found between the two groups with regard to hyponatremia, leukocytosis, and neutrophilia (p>0.05). The risk of complicated appendicitis increased 2.5-fold in patients with elevated CRP (odds ratio: 2.498; 95% confidence interval: 1.558-4.004). Patients with complicated appendicitis had lower baseline serum Na levels (p=0.004; p<0.05). For diagnosis of complicated appendicitis, the cutoff value for Na was ≤138 mEq/L (sensitivity 82.5% and specificity 31.1%). Discussion and Conclusion: It was concluded that blood leukocyte and neutrophil counts in patients with suspected acute appendicitis in the emergency department were not helpful in determining the risk of complicated appendicitis. Although a basal serum Na level ≤138 mEq/L has a high sensitivity in predicting complicated appendicitis, its specificity is low.

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Factors predictive of complicated appendicitis in children

Cited by 78 publications

References 11 publications

Low Plasma Sodium Concentration Predicts Perforated Acute Appendicitis in Children: A Prospective Diagnostic Accuracy Study

Low Plasma Sodium Concentration Predicts Perforated Acute Appendicitis in Children: A Prospective Diagnostic Accuracy Study

Influence of age on clinical presentation, diagnosis delay and outcome in pre-school children with acute appendicitis

Predictive value of serum sodium level in determining complicated appendicitis risk in children

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