Factors contributing to the late diagnosis of appendicitis in children: the results of a retrospective study

Abstract

BACKGROUND: The diagnosis of acute appendicitis in children is often established late, which leads to complications, lethal outcomes are recorded.

AIM: To identify and analyze the factors contributing to the late diagnosis of acute appendicitis in children.

MATERIALS AND METHODS: A retrospective analysis of 279 case histories of children was carried out. The duration of symptoms is divided into “time 1” (before hospitalization) and “time 2” (from hospitalization to surgery). Patients were divided into two groups: 1^st — with destructive uncomplicated appendicitis (phlegmonous, gangrenous), 2^nd — with complicated appendicitis (unrestricted peritonitis, infiltrate, abscess). The causes of late hospitalization, symptoms indicated in the case histories, examinations performed, postoperative complications were analyzed. The diagnosis was established on the basis of intraoperative data, histological examination.

RESULTS: In the 1^st group, time 1 and time 2 were significantly less than in the 2^nd (p < 0.001; 0.028). Late presentation (>24 hours) in 21.9%, misdiagnosis in 12.2% of cases. In the hospital, the observation of the patient >12 hours in 21.1% of patients. The frequency of presence / absence of a description of clinical and laboratory signs of acute appendicitis is from 100 to 19.7%. The 2^nd group was characterized by: duration of symptoms >24 hours, repeated vomiting (p < 0.001), febrile condition (p < 0.001), increase in neutrophils 90% (87–92%). Ultrasound examination with evaluation of the appendix — in 20.1% of cases with a diagnostic accuracy of 89.3%. Laparoscopic appendectomy in 53.2% Alvarado scores are significantly higher in 2^nd group (8–10) than in 1^st group (7–9, p < 0.001). In 1^st group, complications were significantly less than 3.4% than in 2^nd group — 22.7 % (p < 0.001).

CONCLUSIONS: Factors contributing to the late diagnosis of appendicitis in children are: late treatment, diagnostic errors at the prehospital stage, incomplete clinical examination and observation, insufficient use of laboratory and instrumental methods.

Keywords

appendicitis / children / diagnostics / Alvarado scale / laparoscopy / ultrasound

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