• Michelle D Stevenson, Peter S Dayan, Nanette C Dudley, Lalit Bajaj, Charles G Macias, Richard G Bachur, Kelly Sinclair, Jonathan Bennett, Manoj K Mittal, Macarius M Donneyong, Anupam B Kharbanda, and Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.
• Department of Pediatrics, University of Louisville, Louisville, Kentucky; michelle.stevenson@louisville.edu.
• Pediatrics. 2017 Jun 1; 139 (6).

Background And ObjectivesIn patients with appendicitis, the risk of perforation increases with time from onset of symptoms. We sought to determine if time from emergency department (ED) physician evaluation until operative intervention is independently associated with appendiceal perforation (AP) in children.MethodsWe conducted a planned secondary analysis of children aged 3 to 18 years with appendicitis enrolled in a prospective, multicenter, cross-sectional study of patients with abdominal pain (<96 hours). Time of initial physical examination and time of operation were recorded. The presence of AP was determined using operative reports. We analyzed whether duration of time from initial ED physician evaluation to operation impacted the odds of AP using multivariable logistic regression, adjusting for traditionally suggested risk factors that increase the risk of perforation. We also modeled the odds of perforation in a subpopulation of patients without perforation on computed tomography.ResultsOf 955 children with appendicitis, 25.9% (n = 247) had AP. The median time from ED physician evaluation to operation was 7.2 hours (interquartile range: 4.8-8.5). Adjusting for variables associated with perforation, duration of time (≤ 24 hours) between initial ED evaluation and operation did not significantly increase the odds of AP (odds ratio = 1.0, 95% confidence interval, 0.96-1.05), even among children without perforation on initial computed tomography (odds ratio = 0.95, 95% confidence interval, 0.89-1.02).ConclusionsAlthough duration of abdominal pain is associated with AP, short time delays from ED evaluation to operation did not independently increase the odds of perforation.Copyright © 2017 by the American Academy of Pediatrics.

20 keywords...

hide…