Acute appendicitis: is there a difference between children and adults?

Lee, Steven L.; Ho, Hung S.
May 2006
American Surgeon;May2006, Vol. 72 Issue 5, p409
Academic Journal
journal article
Historically, the lack of classic symptoms and delay in presentation make diagnosing acute appendicitis more difficult in children, resulting in a higher perforation rate. Despite this, the morbidity of acute appendicitis is usually lower in children. We evaluated the current differences in clinical presentation, diagnostic clues, and the outcomes of acute appendicitis between the two age groups. A retrospective review of 210 consecutive cases of pediatric appendectomy and 744 adult cases for suspected acute appendicitis from January 1995 to December 2000. Pediatric patients were defined as being 13 years and younger. Pediatric patients were similar to adult patients with respect to duration of pain before presentation (2.4 ± 4.3 days vs 2.5 ± 7.3 days), number of patients previously evaluated (22.0 vs 17.7%), number of imaging tests (computed tomography or ultrasound; 32.9 vs 40.2%), and number of patients observed (16.7 vs 17.2%). However, pediatric patients required less time for emergency room evaluation (4.0 ± 2.7 hours vs 5.7 ± 4.9 hours, P = 0.0001). In children and adults, a history of classic, migrating pain had the highest positive predictive value (94.2 vs 89.6%), followed by a white blood cell count ≥12 x 109/ (91.5 vs 84.3%). The overall negative appendectomy rate was 10.0 per cent for children and 19.0 per cent for adults (P = 0.003); the perforation rate was 19.0 per cent and 13.8 per cent, respectively (P > 0.05). The perforation rate in children was not associated with a delay in presentation (perforated cases, 2.9 ± 3.3 days compared with nonperforated cases, 2.3 ± 4.6 days). Mortality and morbidity, including wound infection rate and intra-abdomlnal abscess rate, were similar. Contrary to traditional teaching, diagnosing acute appendicitis in children is similar to that in adults. A history of migratory pain together with physical findings and leukocytosis remain accurate diagnostic clues for children and adults. Perforation rate and morbidity in children is similar to those in adults. The outcomes of acute appendicitis in children are not associated with a delay in presentation or delay in diagnosis.


Related Articles

  • Survey of gastroenteritis in children admitted to hospital in Newcastle upon Tyne in 1971-5. Pullan, C.R.; Dellagrammatikas, H.; Steiner, H. // British Medical Journal;3/5/1977, Vol. 1 Issue 6061, p619 

    Presents results of a survey on gastroenteritis in children admitted to hospital in Newcastle upon Tyne in 1971-75 in England. Incidence of severe dehydration and hypernatremia; Reduction in the severity of the illness in children with gastroenteritis; Mortality complications in cases of...

  • Norovirus Infection in Children with Acute Gastroenteritis, Madagascar, 2004-2005. Papaventsis, Dimitrios C.; Dove, Winifred; Cunliffe, Nigel A.; Nakagomi, Osamu; Combe, Patrice; Grosjean, Pierre; Hart, C. Anthony // Emerging Infectious Diseases;Jun2007, Vol. 13 Issue 6, p908 

    Of 237 children with acute gastroenteritis in Antananarivo, Madagascar, during May 2004-May 2005, 14 (≈6%) were infected with norovirus. Seasonality (November-December peak) was detected. Reverse transcription-PCR identified GII as the most common genogroup. GIs belonged to GI.1, GI.3, and...

  • Çocuk Acil Servisinde Saptanan Rotavirus Gastroenteriti Olgulannın Sıklığı. Biçer, Suat; Şahin, Gülhan Tunca; Koncay, Berkun; Yavuzcan, Dilek; Gemici, Hakan; Engerek, Nuri; Ulucaklı, Önder; Türkmen, Serdar; Özlü, Nagihan; Erkal, Serdar; Şiraneci, Rengin // Journal of Pediatric Infection / Cocuk Enfeksiyon Dergisi;Sep2008, Vol. 2 Issue 3, p96 

    Aim: Acute gastroenteritis is an important cause of hospital admissions during childhood. The aim of the study was to determine the incidence of rotavirus gastroenteritis in patients admitted to our pediatric emergency department. Material and Methods: Stool specimens of 1767 children admitted...

  • 99mTc-Hexamethylpropyleneamine Oxime (Tc-WBC) scan for... Rypins, Eric B.; Kipper, Samuel L. // American Surgeon;Oct1997, Vol. 63 Issue 10, p878 

    Studies the accuracy of Tc-hexamethylpropyleneamine oxime in diagnosing acute apendicitis in children. Reason why missed diagnosis of appendicitis is a common cause of legal actions against pediatricians; White blood cell (WBC) count requirement for cell labeling; Conventional diagnostic...

  • Treating gastro the right way. Kelly, Elizabeth; Fallows, Carol // Australia's Parents;Oct/Nov97, Issue 101, p29 

    Reports that gastroenteritis is one of the most common childhood illnesses and often its treatment is not only inappropriate but is also potentially dangerous. Big danger with gastroenteritis; Solutions offered for the treatment of gastroenteritis.

  • Apendicitis subhepática con absceso subdiafragmático en paciente pediátrico sin malrotación intestinal. Informe de un caso. Galván-Montaño, Alfonso; Flores-Nava, Gerardo; de Lourdes Suárez-Roa, María; Salazar-Herrera, María Cristina; Lavalle-Villalobos*, Antonio // Cirugia y Cirujanos;ene/feb2010, Vol. 78 Issue 1, p79 

    No abstract available.

  • SYMPTOMS AND SYMPTOM CONTROL IN CHILDREN WITH PROGRESSIVE MALIGNANT DISEASE.  // Archives of Disease in Childhood;Apr2003 Supplement, Vol. 88, pA62 

    Presents an abstract of the study 'Symptoms and Sympton Control in Children With Progressive Malignant Disease--A UKCCSG Survey,' by A. Goldman, M. Hewitt, J. Imesone and M. Childs, presented at the 7th Spring Meeting of the Royal College of Paediatrics and Child Health.

  • Urinary biomarkers in pediatric appendicitis. Salö, Martin; Roth, Bodil; Stenström, Pernilla; Arnbjörnsson, Einar; Ohlsson, Bodil; Salö, Martin; Stenström, Pernilla; Arnbjörnsson, Einar // Pediatric Surgery International;Aug2016, Vol. 32 Issue 8, p795 

    Purpose: The diagnosis of pediatric appendicitis is still a challenge, resulting in perforation and negative appendectomies. The aim of this study was to evaluate novel biomarkers in urine and to use the most promising biomarkers in conjunction with the Pediatric Appendicitis Score...

  • Incidence of rotavirus infection in children with gastroenteritis attending Jos university teaching hospital, Nigeria. Junaid, Surajudeen A.; Umeh, Chijioke; Olabode, Atanda O.; Banda, Jim M. // Virology Journal;2011, Vol. 8 Issue 1, p233 

    This study was conducted to determine the incidence of rotavirus infection in children with gastroenteritis attending Jos university teaching hospital, Plateau State. A total of 160 children with acute diarrhea were selected by random sampling. Stool samples were obtained and assayed for...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics