Bhattacharya Jyotsna, Silver Ellen J, Blumfield Einat, Jan Dominique M, Herold Betsy C, Goldman David L
Pediatric Infectious Disease, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United States.
Academic General Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United States.
Front Pediatr. 2022 Apr 6;10:828748. doi: 10.3389/fped.2022.828748. eCollection 2022.
In children with appendicitis, rupture of the appendix is associated with a significant increase in morbidity. We sought to characterize the spectrum of illness in children with complicated appendicitis and to define those factors associated with a longer hospital stay.
We conducted a retrospective review of 132 children, 18 years of age or younger at a large urban teaching hospital in the Bronx, NY between October 2015 and April 2018 with an intraoperative diagnosis of perforated appendix. Clinical, laboratory and radiologic findings were reviewed, and the primary study outcome was length of stay (LOS) dichotomized at the median, which was 7 days. Statistical analyses were done to characterize morbidity and define variables predictive of longer stay.
Children in the longer LOS group experienced significantly more morbidity, including ICU stay, ileus, and need for multiple drainage procedures. A longer duration of symptoms prior to presentation was associated with a longer stay. Multivariable logistic regression analysis indicated that the presence of abscess and presence of free fluid in the right upper quadrant (RUQ FF) on initial imaging and C-reactive protein (CRP) level >12 at admission, were independently associated with a longer stay.
There is considerable variation in the morbidity of complicated appendicitis. The association between longer stay and the findings of abscess and RUQ FF on initial imaging along with an elevated CRP may provide a useful tool in identifying those children at risk for worse outcomes.
在阑尾炎患儿中，阑尾破裂与发病率显著增加相关。我们试图描述复杂性阑尾炎患儿的疾病谱，并确定与住院时间延长相关的因素。
我们对2015年10月至2018年4月期间在纽约布朗克斯区一家大型城市教学医院接受手术诊断为阑尾穿孔的132名18岁及以下儿童进行了回顾性研究。回顾了临床、实验室和影像学检查结果，主要研究结果是住院时间（LOS），以中位数7天进行二分法划分。进行统计分析以描述发病率并确定预测住院时间延长的变量。
住院时间较长组的儿童发病率明显更高，包括入住重症监护病房、肠梗阻以及需要多次引流手术。就诊前症状持续时间较长与住院时间延长相关。多变量逻辑回归分析表明，初始影像学检查发现脓肿、右上腹游离液体（RUQ FF）以及入院时C反应蛋白（CRP）水平>12与住院时间延长独立相关。
复杂性阑尾炎的发病率存在很大差异。住院时间延长与初始影像学检查发现脓肿和RUQ FF以及CRP升高之间的关联可能为识别那些预后较差风险的儿童提供有用的工具。
