Abstract
Background: Appendicitis is the one of the most common emergency abdominal operation in children. It is estimated that appendicitis is diagnosed in about 2 % of children who present to emergency department because of acute abdominal pain1. Timely diagnosis and appendectomy can prevent abscess formation, perforation as well as reducing early and late postoperative complication.
Methods: This study is a retrospective review of all children diagnosed with acute appendicitis in our emergency department between January 2015 – 2018. We have compared the clinical features and the results of examinations between two group of patients - those who were diagnosed correctly and have been operated,and those who were misdiagnosed and operated later respectively more than 24 hours after initial control.
Results: This study includes fifty-nine children less than sixteen years old, admitted in our clinic and operated due to acute appendicitis. Fifty three (89.9%) of them were hospitalized after the first control, whereas the remining six (10.1 %) were discharged home after the initial control. The misdiagnosed patients were returned in our department less than twenty hours after the first control. Compared with the patients in which the diagnosis was made correctly the misdiagnosed patients in general had lower levels of leukocytes, CRP and temperature.
Conclusion: The diagnosis of appendicitis in children can be very difficult because of the atypical features. According to our experience and the data from other studies, still there is not a single test or combination of clinical and laboratory examinations, able to discriminate children with and without acute appendicitis with a high percentage of accuracy.
References
Hartman GE. Acute appendicitis. In: Behrman RE, Kleigman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders, 2007:1628-34.
Schwartz KL, Gilad E, Sigalet D, Yu W, Wong AL. Neonatal acute appendicitis: a proposed algorithm for timely diagnosis. J Pediatr Surg. 2011; 46: 2060–4.
Anderson JE, Bickler SW, Chang DC, Talamini MA (2012) Examining a common disease with unknown etiology: trends in epidemiology and surgical management of ap- pendicitis in California, 1995-2009. World J Surg 36: 2787- 2794.
Colvin JM, Bachur R, Kharbanda A (2007) The presentation of appendicitis in preadolescent children. Pediatr Emerg Care 23: 849-855.
Chang YJ, Chao HC, Kong MS, Hsia SH, Yan DC. Misdiagnosed acute appendicitis in children in the emergency department. Chang Gung Med J. 2010; 33: 551–7.
Schwartz KL, Gilad E, Sigalet D, Yu W, Wong AL. Neonatal acute appendicitis: a proposed algorithm for timely diagnosis. J Pediatr Surg. 2011; 46: 2060–4.
Khan RA, Menon P, Rao KLN. Beware of neonatal appendicitis. J Indian Assoc Pediatr Surg. 2010; 15: 67–9.
Al-Omran M, Mamdani M, McLeod RS (2003) Epidemiolog- ic features of acute appendicitis in Ontario, Canada. Can J Surg 46: 263-268.
Mandeville K, Monuteaux M, Pottker T, Bulloch B (2015) Ef- fects of Timing to Diagnosis and Appendectomy in Pediatric Appendicitis. Pediatr Emerg Care 31: 753- 758.
Yardeni D, Hirschl RB, Drongowski RA, Teitelbaum DH, Geiger JD, et al. (2004)Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? J Pediatr Surg 39: 464-469.
United Kingdom National Surgical Research Collaborative, Bhangu A (2014) Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta- analysis. Ann Surg 259: 894- 903.
Schwartz KL, Gilad E, Sigalet D, Yu W, Wong AL (2011) Neonatal acute appendicitis: a proposed algorithm for time- ly diagnosis. J Pediatr Surg 46: 2060-2064.
Mandeville K, Monuteaux M, Pottker T, Bulloch B (2015) Ef- fects of Timing to Diagnosis and Appendectomy in Pediatric Appendicitis. Pediatr Emerg Care 31: 753-758.
Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, et al. (2013) Systematic review and meta- analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 100: 322-329.
Beltran MA, Almonacid J, Vicencio A, Gutierrez J, Cruces KS, Cumsille MA. Predictive value of white blood cell count and C-reactive protein in children with appendicitis.J Pediatr Surg 2007;42:1208-14.
Birchley D. Patients with Clinical Acute Appendicitis Should have Pre-Operative Full Blood Count and C-Reactive Protein Assays. Ann R Coll Surg Engl. 2006; 88:27–32.
Wang LT, Prentiss KA, Simon JZ, Doody DP, Ryan DP (2007) The use of white blood cell count and left shift in the diagnosis of appendicitis in children. Pediatr Emerg Care 23: 69-76.
Gavela T, Cabeza B, Serrano A, Casado-Flores J (2012) C-reactive protein and procalcitonin are predictors of the severity of acute appendicitis in children. Pediatr Emerg Care
Kwan KY, Nager AL. Diagnosing pediatric appendicitis: usefulness of laboratory markers. Am J Emerg Med. 2010; 28:10091015
Kamran H, Naveed D, Nazir A, Hameed M, Ahmed M, Khan U. Role of total leukocyte count in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2008; 20: 70–1.
Birchley D. Patients with Clinical Acute Appendicitis Should have Pre-Operative Full Blood Count and C-Reactive Protein Assays. Ann R Coll Surg Engl. 2006; 88: 27–32.
Grönroos J. Do normal leucocyte count and C- reactive protein value exclude acute appendicitis in children? Acta Paediatr. 2001;90: 649–51.
Khan MN, Davie E, Irshad K. The role of white cell count and C-reactive protein in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2004; 16: 17–9.
Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Role of leukocyte count, neutrophil percentage, and C-reactive protein in the diagnosis of acute appendicitis in the elderly. Am Surg. 2005; 71: 344–7.
Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004; 91: 28–37.
Bates MF, Khander A, Steigman SA, Tracy Jr TF, Luks FI. Use of white blood cell count and negative appendectomy rate. Pediatrics. 2014; 133: e39–44.
Kharbanda AB, Cosme Y, Liu K, Spitalnik SL, Dayan PS (2011) Discriminative accuracy of novel and traditional bio- markers in children with suspected appendicitis adjusted for duration of abdominal pain.Acad Emerg Med 18: 567-574.
Gavela T., Serrano A, Casano – Flores J, (2012). C reactive protein and procalcitonin are predictors of the severity of acute appendicitis in children. Pediatric Emergency Care 28 : 416 – 419.
Song XB, Zhao Y and Yang QS. Joint leukocyte classification and C-reactive protein in the diagnosis of acute appendicitis. Chinese Journal of Emergency Medicine 2011; 20: 432-434.
Hosseinpour M, Shahabedin M, Babaee F. Evaluation of the diagnostic value of high sensitive CRP for the diagnosis of 84 caseof acute appendicitis in Shahid Beheshti Hospital (Kashan). Iran J Surg 2009; 17(2):3-46.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.