Clinical Predictors for Ruptured Appendicitis in Children Less than 5 years old
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Abstract
Background: Appendicitisisthe most common pediatric surgical emergency. Clinical appearance in
the patients younger than five years of age is often atypical, and miss diagnosis, whichcanlead to an increased rate of rupture appendicitis resulting in high morbidity.
Objective: To identified clinical predictors for ruptured appendicitis in children less than 5 years of age.
Methods: A retrospective case control study was conducted in Surin hospital from 1st January 2013 to 31st December 2017. Medical records in children less than 5 years old who had surgery for appendicitis were collected. All of which were confirmed to be appendicitis by intraoperative findings and postoperative pathological results. Patients were divided into ruptured appendicitis and non-ruptured appendicitis. Demographic characteristics, clinical presentation, laboratory parameters and pathologic features were collected. General data were analyzed by using exact probability test, t-test. Univariable and multivariable logistic regression were then used to determine independent clinical predictors of ruptured appendicitis.p < 0.05 was considered statistically significant.
Results: Seventy-nine patients were evaluated. Forty–two (53.2%) were ruptured appendicitis.
We found male gender 28(66.7%) in ruptured-appendicitis group. No significant differences in gender, age, bodyweight, pulse rate, blood pressure, white blood cells, neutrophils, white blood cell and red blood cell in urine analysis and duration from diagnosis to operation existed between ruptured appendicitis and non-rupturedappendicitis.Patients with ruptured appendicitis were significantly had longer duration of symptoms(61.0 ± 37.8h versus 23.9±19.7h, p<0.001),Higher rate of diarrhea(47.6% versus 21.6%, p=0.020), higher body temperature (38.5±1.0° Cversus 37.9±0.9°C, p=0.009), and more generalized abdominal tenderness (57.1% versus 8.1%, p<0.001). Multivariable regression analysis identified duration of symptoms longer than 48 hours (AOR, 7.31; 95% CI: 1.39 - 38.46), Body temperature > 38°C(AOR, 4.41; 95% CI: 1.31 - 14.89) and generalized tenderness on abdominal examination (AOR, 8.07; 95% 1.92- 33.88) as independent factors for ruptured appendicitisin children less than 5 years old.
Conclusion: Clinical predictors for ruptured appendicitis in children less than 5 years old were
duration of symptoms longer than 48 hours, Body temperature > 38°C and generalized tenderness on abdominal examination.
Keywords: ruptured appendicitis, children less than 5 years old
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References
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