P PERF APPY

Analysis of predictive factors of perforated appendicitis in children

Harunori Miyauchi 

 

Background

To investigate the diagnostic value of objective factors present at admission for identifying predictive markers of perforated appendicitis in children.

Methods

We performed a retrospective case review of 319 children aged ≤15 years who underwent treatment for acute appendicitis at our institution over a 6‐year period from January 2011 to December 2016. Univariate and multivariate analyses were performed to identify risk factors for perforation of acute appendicitis in children.

Results

In the 6‐year period, 319 patients underwent treatment for acute appendicitis, of whom 72 (22.6%) had perforated appendicitis. Multivariate analysis revealed 5 independent factors predicting perforated appendicitis at admission: longer symptom duration (≥2 days), fever (axillary temperature ≥38.0°C), elevated C‐reactive protein level (≥3.46 mg/dL), appendiceal fecalith on imaging, and ascites on imaging. Among patients with all 5 risk factors, 93.3% had perforated appendicitis. All patients who had none of these factors did not have perforated appendicitis.

Conclusions

Longer symptom duration (≥2 days), fever (axillary temperature ≥38.0°C), elevated C‐reactive protein level, and the presence of appendiceal fecalith and ascites on imaging are independent and objective factors predicting perforated appendicitis at admission. These risk factors have the potential to be helpful as an ancillary index for physicians determining the severity of appendicitis.