Chen Ching-Lun, Chao Hsun-Chin, Kong Man-Shan, Chen Shih-Yen
Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan.
Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan; Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan.
Pediatr Neonatol. 2017 Jun;58(3):223-228. doi: 10.1016/j.pedneo.2016.02.011. Epub 2016 Jul 15.
With effective antibiotics against enteric flora and computed tomography-guided drainage for abscesses, the initial use of nonoperative therapy for children with appendicitis has increased both in recent reports and at our hospital. However, it has been reported that these patients have a relatively longer hospital stay and that their treatment is more expensive than those who undergo aggressive surgical intervention.
This was a retrospective cohort study based in a single medical center. A systemic chart review was conducted to identify risk factors for prolonged hospitalization in pediatric appendicitis patients not initially undergoing surgical treatment. Patient demographics, clinical symptoms, duration of symptoms, laboratory findings, imaging findings, complications, and length of hospital stay were analyzed. Logistic regression analysis was used to identify significant predictors of prolonged hospitalization (≥15 days) and readmission.
One hundred and twenty-five patients were recruited in this study, of whom 53 (42.4%) had prolonged hospitalization. The values of serum C-reactive protein (CRP) were significantly higher in patients with prolonged hospitalization compared with those without prolonged hospitalization (203 ± 108.6 mg/L vs. 140 ± 93.0 mg/L, p = 0.001). Risk factors of prolonged hospitalization were serum CRP >150 mg/L (35/53 vs. 28/72, p = 0.001), abscess formation (38/53 vs. 35/72, p = 0.008), and multiple abscesses (10/53 vs. 1/72, p = 0.001). Under multivariate analysis, CRP >150 mg/L (odds ratio=1.004, p = 0.0334) and multiple abscesses (odds ratio = 8.788, p = 0.044) were two independent predictors for prolonged hospitalization.
Marked elevation of serum CRP (>150 mg/L) and multiple abscesses are two independent risk factors for prolonged hospitalization in children with appendicitis who are initially treated nonoperatively.
随着针对肠道菌群的有效抗生素的应用以及计算机断层扫描引导下的脓肿引流技术的发展，近期报告以及我院中，对阑尾炎患儿初始采用非手术治疗的情况有所增加。然而，有报道称，这些患者的住院时间相对较长，且其治疗费用高于接受积极手术干预的患者。
这是一项基于单一医疗中心的回顾性队列研究。通过系统查阅病历，确定未初始接受手术治疗的小儿阑尾炎患者住院时间延长的危险因素。分析患者的人口统计学特征、临床症状、症状持续时间、实验室检查结果、影像学检查结果、并发症及住院时间。采用逻辑回归分析确定住院时间延长（≥15天）和再次入院的显著预测因素。
本研究共纳入125例患者，其中53例（42.4%）住院时间延长。住院时间延长的患者血清C反应蛋白（CRP）值显著高于未延长的患者（203±108.6mg/L对140±93.0mg/L，p=0.001）。住院时间延长的危险因素为血清CRP>150mg/L（35/53对28/72，p=0.001）、脓肿形成（38/53对35/72，p=0.008）和多发脓肿（10/53对1/72，p=0.001）。多因素分析显示，CRP>l50mg/L（比值比=1.004，p=0.0334）和多发脓肿（比值比=8.788，p=0.044）是住院时间延长的两个独立预测因素。
血清CRP显著升高（>150mg/L）和多发脓肿是初始接受非手术治疗的阑尾炎患儿住院时间延长的两个独立危险因素。
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