Nomura Osamu, Ishiguro Akira, Maekawa Takanobu, Nagai Akira, Kuroda Tatsuo, Sakai Hirokazu
Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Emerg Care. 2012 Aug;28(8):792-5. doi: 10.1097/PEC.0b013e3182628810.
Little is known about the relationship between prior treatment with antibiotics and delay of diagnosis and treatment in pediatric acute appendicitis (AA). We have defined a situation requiring more than 48 hours from the onset of symptoms to surgery in pediatric AA as "therapeutic delay." The aim of this study was to investigate the risk factors contributing to therapeutic delay in pediatric AA.
We conducted a retrospective chart review of AA children operated on between 2003 and 2008 at tertiary-care pediatric and perinatal hospitals. Univariate and multivariate logistic regressions were analyzed to determine independent risk factors of therapeutic delay in pediatric AA.
The duration between the onset of symptoms and surgery was more than 48 hours (therapeutic delay) in 50 patients (25%, group A) and 48 hours or less in 151 patients (75%, group B). The patients in group A had a significantly higher frequency of diarrhea (48% vs 12%; P < 0.0001). The percentages of children who had previously received antibiotics were more frequent in group A (46% vs 8%; P < 0.0001). The median C-reactive protein levels (72 vs 7 mg/L; P < 0.0001) and frequency of perforation (60% vs 13%; P < 0.0001) were statistically significantly higher in group A. A multivariate analysis demonstrated that the independent risk factors of therapeutic delay were history of receiving antibiotics (odds ratio [OR], 5.8; 95% confidence interval [CI], 2.3-15.5), diarrhea (OR, 5.2; 95% CI, 2.1-13.1), and elevated C-reactive protein levels (OR, 4.5; 95% CI, 1.9-10.8).
Prior treatment with antibiotics was an independent risk factor for therapeutic delay in pediatric AA.
关于抗生素的前期治疗与小儿急性阑尾炎（AA）诊断及治疗延迟之间的关系，目前所知甚少。我们将小儿AA患者从症状出现到手术的时间超过48小时的情况定义为“治疗延迟”。本研究旨在调查导致小儿AA治疗延迟的危险因素。
我们对2003年至2008年期间在三级护理儿科和围产期医院接受手术的AA患儿进行了回顾性病历审查。采用单因素和多因素逻辑回归分析来确定小儿AA治疗延迟的独立危险因素。
50例患者（25%，A组）症状出现至手术的时间超过48小时（治疗延迟），151例患者（75%，B组）为48小时或更短。A组患者腹泻发生率显著更高（48%对12%；P<0.0001）。A组中先前接受过抗生素治疗的儿童比例更高（46%对8%；P<0.0001）。A组的C反应蛋白水平中位数（72对7mg/L；P<0.0001）和穿孔发生率（60%对13%；P<0.0001）在统计学上显著更高。多因素分析表明，治疗延迟的独立危险因素为接受抗生素治疗史（比值比[OR]，5.8；95%置信区间[CI]，2.3 - 15.5）、腹泻（OR，5.2；95%CI，2.1 - 13.1）和C反应蛋白水平升高（OR，4.5；95%CI，1.9 - 10.8）。
抗生素的前期治疗是小儿AA治疗延迟的独立危险因素。
