Analysis of Incidence and Risk Factors of Complicated Acute Appendicitis in Children: Evidence From a Tertiary Pediatric Center

Abstract

Background: Acute appendicitis (AA) is the most prevalent surgical emergency in the pediatric population, with the complicated form leading to various adverse outcomes. Our study is aimed at evaluating the incidence and associated risk factors of complicated AA among children presenting with this condition. Methods: Employing a cross-sectional design, we included all children suspected of having AA who were admitted to a tertiary pediatric center in Iran from 2020 to 2021. Pathologists examined all surgically removed appendices, and only cases with histopathological confirmation of AA were included. We classified AA into complicated and uncomplicated categories. We recorded and analyzed demographic, clinical, and laboratory data of patients admitted with AA. Analyzed laboratory parameters included white blood cell (WBC) count, neutrophil count and percentage, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Results: The study comprised 98 pediatric patients with AA, including 60 males (61.2%) and 38 females (38.8%), with a median age of 9.0 (interquartile range: 7.0-11.0) years. Eighteen (18.4%) cases were diagnosed with complicated AA. Mean WBC count, neutrophil count, and CRP levels were significantly higher in patients with complicated AA (p values: 0.048, 0.018, and 0.014, respectively). After adjusting for relevant clinical factors, CRP (odds ratio: 1.02 [95% CI: 1.00-1.04]), WBC count (1.18 [1.03-1.37]), and neutrophil count (1.23 [1.06-1.45)]) were significantly associated with complicated AA. Receiver operating characteristic (ROC) curve analysis indicated a CRP cut-off of 19.5 mg/dL, with an area under the curve of 0.687 (95% CI: 0.551-0.823), a sensitivity of 72.2%, and a specificity of 68.4% for predicting complicated AA. Conclusions: Laboratory parameters, specifically WBC count, neutrophil count, and CRP levels, are significant independent predictors of complicated AA in pediatric patients. These findings could assist in the timely diagnosis and management of children suspected of having AA in clinical practice.

Keywords: Iran; appendicitis; complications; incidence; pediatrics; risk factors.

Figure 1

ROC curve analysis of significant factors associated with complicated acute appendicitis in children, (a) C-reactive protein, (b) white blood cell count, (c) neutrophil count, and (d) all three markers in one model.