Clinical profile, laboratory predictors, and impact of delayed presentation on disease severity in pediatric acute appendicitis

Naveena Thiagarajan; P. Senthil Kumar; S. Kanagabharathi

doi:10.18203/2349-3291.ijcp20262954

Authors

Naveena Thiagarajan Department of Pediatrics, Masonic Medical Centre for Children, Race Course, Coimbatore, Tamil Nadu, India
P. Senthil Kumar Department of Pediatrics, Masonic Medical Centre for Children, Race Course, Coimbatore, Tamil Nadu, India
S. Kanagabharathi Department of Pediatrics, Masonic Medical Centre for Children, Race Course, Coimbatore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20262954

Keywords:

Appendicitis, Child, Disease progression, Hyponatremia, Leukocyte count, Ultrasonography

Abstract

Background: Acute appendicitis is the most common surgical emergency in children, often presenting with variable clinical features leading to diagnostic challenges. Early identification of disease severity is essential to prevent complications. This study aimed to evaluate the clinical profile, laboratory parameters, ultrasonographic findings, and the impact of duration of symptoms prior to presentation on disease severity in paediatric appendicitis.

Methods: This hospital-based prospective observational study was conducted over two years in a tertiary paediatric centre. Seventy-five children under 18 years with suspected acute appendicitis undergoing surgery were included. Data on clinical features, laboratory parameters, imaging findings, timing of surgery, and outcomes were analysed using appropriate statistical methods.

Results: Among 75 children, 56.0% were males, with most in the 7–12 years age group (54.7%). Simple appendicitis was observed in 68.0% and complicated in 32.0%. Abdominal pain (94.7%) and tenderness (98.7%) were predominant. Ultrasonography identified acute appendicitis in 72.0% and showed significant association with severity (p=0.0005). Complicated appendicitis had higher WBC counts (p=0.001) and lower serum sodium levels (p=0.009). Longer duration of symptoms prior to presentation (3–5 days) was associated with increased complications (50.0%) (p=0.050). Hospital stay was longer in complicated cases (p=0.0005).

Conclusion: Clinical evaluation supported by laboratory markers and ultrasonography aids in assessing disease severity. Early presentation and timely management are associated with reduced complications, while delayed presentation increases morbidity in paediatric appendicitis.

Metrics

Metrics Loading ...

References

Koberlein GC, Trout AT, Rigsby CK, Iyer RS, Alazraki AL, et al. ACR appropriateness criteria® suspected appendicitis-child. J Am Coll Radiol. 2019;16:252–63. DOI: https://doi.org/10.1016/j.jacr.2019.02.022

Kliegman RM, editor. Nelson Textbook of Pediatrics: First South Asia Edition, 3 volume set. New Delhi, India: Elsevier. 2015.

Pham X-BD, Sullins VF, Kim DY, Range B, Kaji AH, de Virgilio CM, et al. Factors predictive of complicated appendicitis in children. J Surg Res. 2016;206:62–6. DOI: https://doi.org/10.1016/j.jss.2016.07.023

Buschard K, Kjaeldgaard A. Investigation and analysis of the position, fixation, length and embryology of the vermiform appendix. Acta Chir Scand. 1973;139:293–8.

Yang J, Liu C, He Y, Cai Z. Laboratory markers in the prediction of acute perforated appendicitis in children. Emerg Med Int. 2019;2019:4608053. DOI: https://doi.org/10.1155/2019/4608053

Brumer M. Appendicitis. Seasonal incidence and postoperative wound infection. Br J Surg. 1970;57:93–9. DOI: https://doi.org/10.1002/bjs.1800570204

Gosain A, Williams RF, Blakely ML. Distinguishing acute from ruptured appendicitis preoperatively in the pediatric patient. Adv Surg. 2010;44:73–85. DOI: https://doi.org/10.1016/j.yasu.2010.05.021

Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med. 2000;36:39–51. DOI: https://doi.org/10.1067/mem.2000.105658

Puri P, Boyd E, Guiney EJ, O’Donnell B. Appendix mass in the very young child. J Pediatr Surg. 1981;16:55–7. DOI: https://doi.org/10.1016/S0022-3468(81)80115-7

Larson DB, Trout AT, Fierke SR, Towbin AJ. Improvement in diagnostic accuracy of ultrasound of the pediatric appendix through the use of equivocal interpretive categories. AJR Am J Roentgenol. 2015;204:849–56. DOI: https://doi.org/10.2214/AJR.14.13026

Oguntola AS, Adeoti ML, Oyemolade TA. Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria. Ann Afr Med. 2010;9:213–7. DOI: https://doi.org/10.4103/1596-3519.70956

Teo ATK, Lefter LP, Zarrouk AJM, Merrett ND. Institutional review of patients presenting with suspected appendicitis: Patients with suspected appendicitis. ANZ J Surg. 2015;85:420–4. DOI: https://doi.org/10.1111/ans.12531

Lin K-B, Lai KR, Yang N-P, Chan C-L, Liu Y-H, Pan R-H, et al. Epidemiology and socioeconomic features of appendicitis in Taiwan: a 12-year population-based study. World J Emerg Surg. 2015;10:42. DOI: https://doi.org/10.1186/s13017-015-0036-3

Lee SL, Stark R, Yaghoubian A, Shekherdimian S, Kaji A. Does age affect the outcomes and management of pediatric appendicitis. J Pediatr Surg. 2011;46:2342–5. DOI: https://doi.org/10.1016/j.jpedsurg.2011.09.030

van den Boom AL, Gorter RR, van Haard PMM, Doornebosch PG, Heij HA, Dawson I. The impact of disease severity, age and surgical approach on the outcome of acute appendicitis in children. Pediatr Surg Int. 2015;31:339–45. DOI: https://doi.org/10.1007/s00383-015-3677-0

Okamoto T, Sano K, Ogasahara K. Receiver-operating characteristic analysis of leukocyte counts and serum C-reactive protein levels in children with advanced appendicitis. Surg Today. 2006;36:515–8. DOI: https://doi.org/10.1007/s00595-006-3189-6

Laméris W, van Randen A, Go PMNYH, Bouma WH, Donkervoort SC, Bossuyt PMM, et al. Single and combined diagnostic value of clinical features and laboratory tests in acute appendicitis. Acad Emerg Med. 2009;16:835–42. DOI: https://doi.org/10.1111/j.1553-2712.2009.00486.x

Alloo J, Gerstle T, Shilyansky J, Ein SH. Appendicitis in children less than 3 years of age: a 28-year review. Pediatr Surg Int. 2004;19:777–9. DOI: https://doi.org/10.1007/s00383-002-0775-6

Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg. 2006;202:401–6. DOI: https://doi.org/10.1016/j.jamcollsurg.2005.11.016

Kaneko K, Tsuda M. Ultrasound-based decision making in the treatment of acute appendicitis in children. J Pediatr Surg. 2004;39:1316–20. DOI: https://doi.org/10.1016/j.jpedsurg.2004.05.011

Sack U, Biereder B, Elouahidi T, Bauer K, Keller T, Tröbs R-B. Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children. BMC Surg. 2006;6:15. DOI: https://doi.org/10.1186/1471-2482-6-15

Celik B, Nalcacioglu H, Ozcatal M, Altuner Torun Y. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg. 2019;25:222–8. DOI: https://doi.org/10.5505/tjtes.2018.06709

Zani A, Teague WJ, Clarke SA, Haddad MJ, Khurana S, Tsang T, et al. Can common serum biomarkers predict complicated appendicitis in children. Pediatr Surg Int. 2017;33:799–805. DOI: https://doi.org/10.1007/s00383-017-4088-1

Kim DY, Nassiri N, de Virgilio C, Ferebee MP, Kaji AH, Hamilton CE, et al. Association between hyponatremia and complicated appendicitis. JAMA Surg. 2015;150:911–2. DOI: https://doi.org/10.1001/jamasurg.2015.1258

Romano A, Parikh P, Byers P, Namias N. Simple acute appendicitis versus non-perforated gangrenous appendicitis: is there a difference in the rate of post-operative infectious complications. Surg Infect. 2014;15:517–20. DOI: https://doi.org/10.1089/sur.2013.106