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Pediatric appendicitis: state of the art review

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Abstract

Appendicitis is a common cause of abdominal pain in children. The diagnosis and treatment of the disease have undergone major changes in the past two decades, primarily as a result of the application of an evidence-based approach. Data from several randomized controlled trials, large database studies, and meta-analyses have fundamentally affected patient care. The best diagnostic approach is a standardized clinical pathway with a scoring system and selective imaging. Non-operative management of simple appendicitis is a reasonable option in selected cases, with the caveat that data in children remain limited. A minimally invasive (laparoscopic) appendectomy is the current standard in US and European children’s hospitals. This article reviews the current ‘state of the art’ in the evaluation and management of pediatric appendicitis.

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Abbreviations

AIR:

Appendicitis inflammatory response

BMI:

Body mass index

CI:

Confidence interval

CRP:

C-reactive protein

CT:

Computed tomography

ED:

Emergency department

GALT:

Gut-associated lymphoid tissue

ICU:

Intensive care unit

IR:

Interventional Radiology

LOS:

Length of stay

LR:

Likelihood ratio

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

NSQIP:

National Surgical Quality Improvement Program

PA:

Perforated appendicitis

PAS:

Pediatric Appendicitis Score

PHIS:

Pediatric Health Information Systems

PPV:

Positive predictive value

RCT:

Randomized controlled trial

SSI:

Surgical site infection

US:

Ultrasound

WBC:

White blood cell

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  1. Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas, MO, 64108, USA

    Rebecca M. Rentea, Shawn D. St. Peter & Charles L. Snyder

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Rentea, R.M., Peter, S.D.S. & Snyder, C.L. Pediatric appendicitis: state of the art review. Pediatr Surg Int 33, 269–283 (2017). https://doi.org/10.1007/s00383-016-3990-2

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