Michelle D Stevenson1, Peter S Dayan2, Nanette C Dudley3, Lalit Bajaj4, Charles G Macias5, Richard G Bachur6, Kelly Sinclair7, Jonathan Bennett8, Manoj K Mittal9, Macarius M Donneyong10, Anupam B Kharbanda11. 1. Department of Pediatrics, University of Louisville, Louisville, Kentucky; michelle.stevenson@louisville.edu. 2. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York. 3. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah. 4. Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado. 5. Department of Pediatrics, Baylor College of Medicine, Houston, Texas. 6. Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 7. Division of Emergency Medicine, Children's Mercy Hospital, Kansas City, Missouri. 8. Department of Pediatrics, Alfred I. DuPont Hospital for Children, Wilmington, Delaware. 9. Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennyslvania. 10. Division of Pharmacy Practice and Science, College of Pharmacy, The Ohio State University, Columbus, Ohio; and. 11. Department of Pediatric Emergency Medicine, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota.
Abstract
BACKGROUND AND OBJECTIVES: In patients with appendicitis, the risk of perforation increases with time from onset of symptoms. We sought to determine if time from emergency department (ED) physician evaluation until operative intervention is independently associated with appendiceal perforation (AP) in children. METHODS: We conducted a planned secondary analysis of children aged 3 to 18 years with appendicitis enrolled in a prospective, multicenter, cross-sectional study of patients with abdominal pain (<96 hours). Time of initial physical examination and time of operation were recorded. The presence of AP was determined using operative reports. We analyzed whether duration of time from initial ED physician evaluation to operation impacted the odds of AP using multivariable logistic regression, adjusting for traditionally suggested risk factors that increase the risk of perforation. We also modeled the odds of perforation in a subpopulation of patients without perforation on computed tomography. RESULTS: Of 955 children with appendicitis, 25.9% (n = 247) had AP. The median time from ED physician evaluation to operation was 7.2 hours (interquartile range: 4.8-8.5). Adjusting for variables associated with perforation, duration of time (≤ 24 hours) between initial ED evaluation and operation did not significantly increase the odds of AP (odds ratio = 1.0, 95% confidence interval, 0.96-1.05), even among children without perforation on initial computed tomography (odds ratio = 0.95, 95% confidence interval, 0.89-1.02). CONCLUSIONS: Although duration of abdominal pain is associated with AP, short time delays from ED evaluation to operation did not independently increase the odds of perforation.
BACKGROUND AND OBJECTIVES: In patients with appendicitis, the risk of perforation increases with time from onset of symptoms. We sought to determine if time from emergency department (ED) physician evaluation until operative intervention is independently associated with appendiceal perforation (AP) in children. METHODS: We conducted a planned secondary analysis of children aged 3 to 18 years with appendicitis enrolled in a prospective, multicenter, cross-sectional study of patients with abdominal pain (<96 hours). Time of initial physical examination and time of operation were recorded. The presence of AP was determined using operative reports. We analyzed whether duration of time from initial ED physician evaluation to operation impacted the odds of AP using multivariable logistic regression, adjusting for traditionally suggested risk factors that increase the risk of perforation. We also modeled the odds of perforation in a subpopulation of patients without perforation on computed tomography. RESULTS: Of 955 children with appendicitis, 25.9% (n = 247) had AP. The median time from ED physician evaluation to operation was 7.2 hours (interquartile range: 4.8-8.5). Adjusting for variables associated with perforation, duration of time (≤ 24 hours) between initial ED evaluation and operation did not significantly increase the odds of AP (odds ratio = 1.0, 95% confidence interval, 0.96-1.05), even among children without perforation on initial computed tomography (odds ratio = 0.95, 95% confidence interval, 0.89-1.02). CONCLUSIONS: Although duration of abdominal pain is associated with AP, short time delays from ED evaluation to operation did not independently increase the odds of perforation.