Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis
ObjectiveIn 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 DesignWe conduc...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-04-01
|
| Series: | Frontiers in Pediatrics |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.828748/full |
| _version_ | 1818348838406062080 |
|---|---|
| author | Jyotsna Bhattacharya Ellen J. Silver Einat Blumfield Dominique M. Jan Betsy C. Herold Betsy C. Herold David L. Goldman David L. Goldman |
| author_facet | Jyotsna Bhattacharya Ellen J. Silver Einat Blumfield Dominique M. Jan Betsy C. Herold Betsy C. Herold David L. Goldman David L. Goldman |
| author_sort | Jyotsna Bhattacharya |
| collection | DOAJ |
| description | ObjectiveIn 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 DesignWe 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.ResultsChildren 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.ConclusionThere 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. |
| first_indexed | 2024-12-13T17:56:25Z |
| format | Article |
| id | doaj.art-49604916b7f943e59b73ec37c172d5fe |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-13T17:56:25Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-49604916b7f943e59b73ec37c172d5fe2022-12-21T23:36:22ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-04-011010.3389/fped.2022.828748828748Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated AppendicitisJyotsna Bhattacharya0Ellen J. Silver1Einat Blumfield2Dominique M. Jan3Betsy C. Herold4Betsy C. Herold5David L. Goldman6David L. Goldman7Pediatric Infectious Disease, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United StatesAcademic General Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United StatesPediatric Radiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United StatesPediatric Surgery, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United StatesPediatric Infectious Disease, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United StatesDepartment of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, United StatesPediatric Infectious Disease, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United StatesDepartment of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, United StatesObjectiveIn 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 DesignWe 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.ResultsChildren 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.ConclusionThere 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.https://www.frontiersin.org/articles/10.3389/fped.2022.828748/fullappendicitisabscessimagingmicrobiologyantibiotics |
| spellingShingle | Jyotsna Bhattacharya Ellen J. Silver Einat Blumfield Dominique M. Jan Betsy C. Herold Betsy C. Herold David L. Goldman David L. Goldman Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis Frontiers in Pediatrics appendicitis abscess imaging microbiology antibiotics |
| title | Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis |
| title_full | Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis |
| title_fullStr | Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis |
| title_full_unstemmed | Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis |
| title_short | Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis |
| title_sort | clinical laboratory and radiographic features associated with prolonged hospitalization in children with complicated appendicitis |
| topic | appendicitis abscess imaging microbiology antibiotics |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.828748/full |
| work_keys_str_mv | AT jyotsnabhattacharya clinicallaboratoryandradiographicfeaturesassociatedwithprolongedhospitalizationinchildrenwithcomplicatedappendicitis AT ellenjsilver clinicallaboratoryandradiographicfeaturesassociatedwithprolongedhospitalizationinchildrenwithcomplicatedappendicitis AT einatblumfield clinicallaboratoryandradiographicfeaturesassociatedwithprolongedhospitalizationinchildrenwithcomplicatedappendicitis AT dominiquemjan clinicallaboratoryandradiographicfeaturesassociatedwithprolongedhospitalizationinchildrenwithcomplicatedappendicitis AT betsycherold clinicallaboratoryandradiographicfeaturesassociatedwithprolongedhospitalizationinchildrenwithcomplicatedappendicitis AT betsycherold clinicallaboratoryandradiographicfeaturesassociatedwithprolongedhospitalizationinchildrenwithcomplicatedappendicitis AT davidlgoldman clinicallaboratoryandradiographicfeaturesassociatedwithprolongedhospitalizationinchildrenwithcomplicatedappendicitis AT davidlgoldman clinicallaboratoryandradiographicfeaturesassociatedwithprolongedhospitalizationinchildrenwithcomplicatedappendicitis |