Appendicitis in preschool aged children: Regression analysis of factors associated with perforation outcome ★

ObjectivesApply multivariate regression analysis to determine the significance of clinical variables for perforation outcome of a large series of preschool aged children with appendicitis.MethodsRetrospective case review of 180 consecutive children < 5 years of age diagnosed with appendicitis during an 8-year period.ResultsThis age group accounted for only 9% of all cases of pediatric appendicitis at our institution during the study period. Perforation rate was inversely proportional to patient age, occurring in 100% aged < 1 year, 91% ages 1–2 years, 76% ages 2–3 years, 73% ages 3–4 years, and 57% ages 4–5 years. Risk for perforation increased proportionately with duration of symptoms, ranging from 48% when < 1 day vs 84% when > 1 day; and 93% when > 2 days. One-quarter with perforation had a prior recent medical evaluation with an alternative diagnosis rendered preappendicitis diagnosis. The mean duration of hospitalization was four times longer in those with perforation [8 days] vs no perforation [2 days]. Univariate analysis showed each of the following factors was significantly associated with perforation outcome: younger patient age, female gender, prior medical visit < 48 hours of appendicitis diagnosis, symptom duration, presence of fever, and presence of appendicolith. Multivariate logistic regression combining all significant univariate predictors showed only duration of symptoms and presence of appendicolith were significantly associated with perforation outcome; receiver-operating characteristic curves are generated to evaluate the predictive accuracy of these two factors, both individually and when combined.ConclusionsAlthough relatively uncommon in this age group, appendicitis is frequently associated with delayed diagnosis and perforation outcome. Risk for perforation is directly proportional to increasing duration of symptoms. Clinicians must maintain a high index of suspicion for this condition in these younger children, as early diagnosis is essential to maximizing outcome.