Children and Appendicitis, Our Journey in DGH
Fady Hatem, Charlotte Cardus, Rabia Waqar, Olamid Olatokum ,Adeel Dhahri, Foad Kadus
Appendicitis is a common acute pediatric surgical condition. Clinical examination is often supplemented by blood tests and imaging. We aim to examine our experience with clinically suspected appendicitis in the pediatric population cohort including negative appendectomy rates(NAR), inflammatory markers, and imaging appraisal.
Retrospective analysis of children (5-15years)referred to surgeons in our institution over a one year period. Data collected included diagnostic investigations, operative management and NAR.
Overall 220children were referred with possible appendicitis. 100(50%) cases admitted. (80)cases had appendectomy, (58%)were females, with NAR(38%) in comparison with (20%)NAR in males. Further stratification according to the age of female patients into (5-8),(9-12)and(13-15)subgroups, NAR was (0%,40%,47%)respectively.
Further correlation with blood tests showed the best diagnostic value was within(5-8)subgroup with sensitivity and specificity(>90%). Specificity of blood tests was the highest in the (13-15)subgroup at(90%) which had the highest NAR.
USS was done in (65%)of females underwent appendectomy, in(50%) appendix was not visualized and two thirds of these patients had inflamed appendix. The utility of USS In male patient was much less at(40%)and appendix was not visible in(19%). The use of CTscan and MRI was very limited.
our overall NAR is (5%)above national rate, females are at higher risk especially(9-15)age group. Blood tests are of higher diagnostic value among males and (5-8)females. But in older females imaging are recommended to aid in the diagnosis. The utility of CTscan and MRI was very limited and should be encouraged to lower NAR beside USS which had low diagnostic value in our study.