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. 2022 Apr 6:10:828748.
doi: 10.3389/fped.2022.828748. eCollection 2022.

Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis

Jyotsna Bhattacharya  1 , Ellen J Silver  2 , Einat Blumfield  3 , Dominique M Jan  4 , Betsy C Herold  1   5 , David L Goldman  1   5
Affiliations

Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis

Jyotsna Bhattacharya et al. Front Pediatr. .

Abstract

Objective: In children with appendicitis, rupture of the appendix is associated with a significant increase in morbidity. We sought to characterize the spectrum of illness in children with complicated appendicitis and to define those factors associated with a longer hospital stay.

Study design: We conducted a retrospective review of 132 children, 18 years of age or younger at a large urban teaching hospital in the Bronx, NY between October 2015 and April 2018 with an intraoperative diagnosis of perforated appendix. Clinical, laboratory and radiologic findings were reviewed, and the primary study outcome was length of stay (LOS) dichotomized at the median, which was 7 days. Statistical analyses were done to characterize morbidity and define variables predictive of longer stay.

Results: Children in the longer LOS group experienced significantly more morbidity, including ICU stay, ileus, and need for multiple drainage procedures. A longer duration of symptoms prior to presentation was associated with a longer stay. Multivariable logistic regression analysis indicated that the presence of abscess and presence of free fluid in the right upper quadrant (RUQ FF) on initial imaging and C-reactive protein (CRP) level >12 at admission, were independently associated with a longer stay.

Conclusion: There is considerable variation in the morbidity of complicated appendicitis. The association between longer stay and the findings of abscess and RUQ FF on initial imaging along with an elevated CRP may provide a useful tool in identifying those children at risk for worse outcomes.

Keywords: abscess; antibiotics; appendicitis; imaging; microbiology.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Intraperitonal culture results. Shown (above the bars) are the percentages of the most common bacterial species isolated from intraperitoneal cultures by LOS cohort. *The numbers do not add up to 100 percent as many of the cultures were polymicrobial.
See this image and copyright information in PMC

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