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A model predicting perforation and complications in paediatric appendicectomy

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Abstract

Purpose

To analyse the diagnostic value of simple clinical measurements in ensuring an early and accurate detection of advanced appendicitis (perforation, mass and peri-appendicular abscess) and possible complications.

Methods

A retrospective, single-centre study of all paediatric (age 0–14 years) appendicectomies was conducted over a 14-year period. Preoperative symptoms, signs and laboratory results, intra-operative findings and postoperative complications were analyzed. Receiver operating characteristic (ROC) curves were used to estimate sensitivity and specificity of significant (p ≤ 0.05) predictor variables based on multivariate logistic regression models.

Results

One thousand and thirty-seven patients were included. Perforations were seen in 88 (8.5 %) cases, and abscesses were seen in 35 (3.4 %) cases. Of all the clinical variables evaluated, preoperative temperature ≥37.5 °C was most discriminatory for advanced appendicitis. Significant other discriminatory clinical variables were WBC count ≥15,100/μL, preoperative anorexia and rebound tenderness. Postoperative complications occurred in 74 (7.1 %) patients and were associated with pre-operative temperature ≥37.5 °C and advanced appendicitis.

Conclusion

Independent clinical predictors of advanced appendicitis exist but lack individual accuracy. In this study, preoperative pyrexia is shown to be highly associated with both advanced appendicitis and development of postoperative complications. This independent factor may point to early need for antibiotic treatment, urgent imaging and subsequent intervention in patients with appendicitis.

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Acknowledgment

The authors thank the Late Mr. Nicola Motterlini for statistical support at the early stages of the research work. The authors also thank Ms. Caitriona Canning and Mr. Ian Robertson for editing the revised manuscript.

Conflict of interest

All authors have no conflict of interest to disclose.

Author information

Author notes

  1. Obinna Obinwa

    Present address: Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland

  2. Colin Peirce

    Present address: Department of Surgery, St Vincent University Hospital, Dublin, Ireland

Authors and Affiliations

  1. Department of Surgery, Portiuncula Hospital, Ballinasloe, County Galway, Ireland

    Obinna Obinwa, Colin Peirce & John Flynn

  2. Department of Pathology, Portiuncula Hospital, Ballinasloe, County Galway, Ireland

    Michael Cassidy

  3. Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland

    Tom Fahey

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  1. Obinna Obinwa
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  2. Colin Peirce
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  4. Tom Fahey
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  5. John Flynn
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Correspondence to Obinna Obinwa.

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Obinwa, O., Peirce, C., Cassidy, M. et al. A model predicting perforation and complications in paediatric appendicectomy. Int J Colorectal Dis 30, 559–565 (2015). https://doi.org/10.1007/s00384-015-2120-2

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