Pediatric appendicitis: the prevalence of systemic inflammatory response syndrome upon presentation and its association with clinical outcomes.

INTRODUCTION

To our knowledge, the prevalence of Systemic Inflammatory Response Syndrome (SIRS) in pediatric patients with appendicitis has not been previously investigated. Our specific aim was to determine the prevalence of SIRS at the time of presentation of pediatric patients with appendicitis. Additionally, we sought to determine if the presence of SIRS had any value in predicting their clinical outcomes.

METHODS

This retrospective cohort study included pediatric patients (age <17 years) presenting to a single hospital and being diagnosed with appendicitis between July 1, 2011, and June 30, 2012. The primary exposure variable of interest was SIRS, dichotomously defined as positive or negative. The primary outcome of interest was the presence/development of an intraabdominal abscess. The secondary outcome of interest was length of hospital stay (LOS). Chi-squared and t-tests were used to evaluate the association between presence of SIRS and development of abscess and LOS.

RESULTS

This study consisted of 212 patients. The definition of SIRS was met in 66 patients (31.1%). Thirty of the 66 (45.6%) patients with SIRS had/developed an abscess versus 28 (19.2%) of those without SIRS (P<0.001). Patients with SIRS had a mean LOS of 4 days (+/-2.7), while those without SIRS stayed a mean of 2.5 days (+/-2.3) [p<0.0001]). Adjusting for age did not alter these associations.

CONCLUSION

Our study found a 31.1% prevalence of SIRS in pediatric patients presenting with appendicitis. Our results suggest these patients with SIRS have a significantly higher risk of having/developing an intraabdominal abscess (RR, 2.4; 95% CI: 1.6-3.6) and significantly longer LOS.