Perforated appendicitis in children: Is there a best treatment?

Donald E. Meier, P. C. Guzzetta, R. G. Barber, L. S. Hynan, R. Seetharamaiah

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Purpose: This study was performed to provide outcome data for the development of evidenced-based management techniques for children with appendicitis in the authors' hospital. Methods: This is a retrospective analysis of 1,196 consecutive children with appendicitis over a 5-year period (1996 to 2001) at a metropolitan hospital. Results: The median age was 9 years (7 months to 18 years). The perforation rate was 38.9%, and the nonappendicitis rate was 5.6%. Predictors of perforation included age less than 8 years, Hispanic ethnicity, generalized abdominal tenderness, rebound tenderness, and increased number of bands. In perforated cases, the median length of stay was 5 days, and the complication rate was 13.5%. There was no difference in complication rates related to type or timing of antibiotics or related to the individual surgeon. There was no difference in infection rates related to type of wound management. Conclusions: Children with perforated appendicitis are treated effectively by a less expensive broad-spectrum antibiotic regimen, expeditious operation by open or laparoscopic technique, primary wound closure, and postoperative intravenous antibiotics until they are afebrile for 24 hours and have a white blood cell count of less than 12,000/mm3. This approach is to be used in our prospective, randomized analysis of children treated on or off a clinical pathway.

Original languageEnglish (US)
Pages (from-to)1520-1524
Number of pages5
JournalJournal of Pediatric Surgery
Volume38
Issue number10
DOIs
StatePublished - Oct 1 2003

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Keywords

  • Evidence-based management
  • Perforated appendicitis

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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