Advertisement

Pediatric Surgery International

, Volume 25, Issue 3, pp 277–282 | Cite as

Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis

  • Yusuf Hakan Çavuşoğlu
  • Derya Erdoğan
  • Ayşe Karaman
  • Mustafa K. Aslan
  • İbrahim Karaman
  • Özden Ç. Tütün
Original Article

Abstract

Purpose

The aim of this study was to determine whether the admission and active observation of children where the diagnosis of acute appendicitis is uncertain is a safe and effective way to improve the diagnostic accuracy of appendicitis and safely reduce the incidence of negative laparotomies without increasing complications.

Methods

We performed a retrospective cohort study of children who presented with a complaint of right lower quadrant pain and were hospitalized with a diagnosis of appendicitis or suspected appendicitis from 1 January to 31 December 2007.

Results

A total of 569 patients were included in the study. The mean age was 9.5 ± 3.2 (range 1.1–17) years. The number of patients directly operated on with a diagnosis of appendicitis was 186 (32%) from the total of 575 while 389 patients (68%) were observed in the surgical ward as the examination and/or investigation findings were equivocal. Of the 383 patients admitted for observation, 173 (45%) were operated on with a suspicion of appendicitis after 14.4 ± 6.7 h while 210 (55%) were discharged after 1.1 ± 1.2 days as there seemed to have no surgical problem. Our total negative appendectomy rate was 4% (14/350) and total perforation rate was 37.4% (131/350). The patients operated on directly and those operated on after observation were similar, and there was no difference for the preoperative duration of symptom, histopathological diagnosis, postoperative complication rate, postoperative inpatient days and hospital charges. Total hospitalization duration was significantly longer and the hospital charges significantly higher in the negative appendectomy group.

Conclusion

Both the features and results and the complication rates and costs of the group operated on after observation were the same as the directly operated on group. However, patients undergoing a negative appendectomy stayed as inpatients longer than only observation patients with higher treatment charges. We could therefore decrease the negative appendectomy rate, the associated cost and duration of hospitalization without causing extra complications if we observe and investigate patients with right lower quadrant pain with a doubtful diagnosis and did not operate on them directly.

Keywords

Abdominal pain Appendicitis Diagnostic errors Hospitalization Child 

Notes

Acknowledgments

The authors thank Salih Ergöçen, MSc for his statistical evaluation and Aydın Yuluğ, MD for his English language revision.

References

  1. 1.
    Pearl RH, Hale DA, Molloy M et al (1995) Pediatric appendectomy. J Pediatr Surg 30:173–178. doi: 10.1016/0022-3468(95)90556-1 PubMedCrossRefGoogle Scholar
  2. 2.
    Lelli JL Jr, Drongowski RA, Raviz S et al (2000) Historical changes in the postoperative treatment of appendicitis in children: impact on medical outcome. J Pediatr Surg 35:239–244. doi: 10.1016/S0022-3468(00)90017-4 PubMedCrossRefGoogle Scholar
  3. 3.
    Ravitch MM (1982) Appendicitis. Pediatrics 70:414–419PubMedGoogle Scholar
  4. 4.
    Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97–132. doi: 10.1016/S0196-6553(99)70088-X Quiz 133–134; discussion 96PubMedCrossRefGoogle Scholar
  5. 5.
    Flum DR, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 137:799–804. doi: 10.1001/archsurg.137.7.799 PubMedCrossRefGoogle Scholar
  6. 6.
    Flum DR, Morris A, Koepsell T et al (2001) Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 286:1748–1753. doi: 10.1001/jama.286.14.1748 PubMedCrossRefGoogle Scholar
  7. 7.
    Neilson IR, Laberge JM, Nguyen LT et al (1990) Appendicitis in children: current therapeutic recommendations. J Pediatr Surg 25:1113–1116. doi: 10.1016/0022-3468(90)90742-R PubMedCrossRefGoogle Scholar
  8. 8.
    Kosloske AM, Love CL, Rohrer JE et al (2004) The diagnosis of appendicitis in children: outcomes of a strategy based on pediatric surgical evaluation. Pediatrics 113:29–34. doi: 10.1542/peds.113.1.29 PubMedCrossRefGoogle Scholar
  9. 9.
    Andersson R, Hugander A, Thulin A et al (1994) Indications for operation in suspected appendicitis and incidence of perforation. Br Med J 308:107–110Google Scholar
  10. 10.
    Velanovich V, Satava R (1992) Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg 58:264–269PubMedGoogle Scholar
  11. 11.
    Eldar S, Nash E, Sabo E et al (1997) Delay of surgery in acute appendicitis. Am J Surg 173:194–198. doi: 10.1016/S0002-9610(96)00011-6 PubMedCrossRefGoogle Scholar
  12. 12.
    Dolgin SE, Beck AR, Tartter PI (1992) The risk of perforation when children with possible appendicitis are observed in the hospital. Surg Gynecol Obstet 175:320–324PubMedGoogle Scholar
  13. 13.
    Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296PubMedGoogle Scholar
  14. 14.
    Garcia Peña BM, Mandl KD, Kraus SJ et al (1999) Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA 282:1041–1046. doi: 10.1001/jama.282.11.1041 PubMedCrossRefGoogle Scholar
  15. 15.
    Lee SL, Walsh AJ, Ho HS (2001) Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg 136:556–562. doi: 10.1001/archsurg.136.5.556 PubMedCrossRefGoogle Scholar
  16. 16.
    Warner BW, Kulick RM, Stoops MM et al (1998) An evidence-based clinical pathway for acute appendicitis decreases hospital duration and cost. J Pediatr Surg 33:1371–1375. doi: 10.1016/S0022-3468(98)90010-0 PubMedCrossRefGoogle Scholar
  17. 17.
    Curran TJ, Muenchow SK (1993) The treatment of complicated appendicitis in children using peritoneal drainage: results from a public hospital. J Pediatr Surg 28:204–208. doi: 10.1016/S0022-3468(05)80276-3 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Yusuf Hakan Çavuşoğlu
    • 1
  • Derya Erdoğan
    • 1
  • Ayşe Karaman
    • 1
  • Mustafa K. Aslan
    • 1
  • İbrahim Karaman
    • 1
  • Özden Ç. Tütün
    • 1
  1. 1.Dr. Sami Ulus Children’s HospitalAnkaraTurkey

Personalised recommendations