Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA.
Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
Pediatr Surg Int. 2024 Nov 5;40(1):290. doi: 10.1007/s00383-024-05873-z.
Hospital length of stay (LOS) following admission for appendicitis is difficult to predict. Shock index, pediatric age adjusted (SIPA) accurately identifies severely injured trauma patients and predicts mortality among children admitted to the ICU. Our aim was to determine if elevated SIPA at presentation, and time to normalization of SIPA, can identify children with perforated appendicitis and predict hospital LOS.
This was a retrospective cohort study of children 1-17 years admitted to a quaternary care referral center with appendicitis after appendectomy in 2021. The primary outcomes were presence of perforated appendicitis and hospital LOS. Generalized linear regressions were performed. Covariates included in all models were age, sex, fecalith, initial temperature, and time from diagnosis to OR.
We included 169 patients; 53 (31.4%) had perforated appendicitis. After adjustment, elevated SIPA was associated with presence of perforated appendicitis (p = 0.0002) and longer LOS (p < 0.0001). A patient presenting with appendicitis and elevated SIPA had 5.447 times higher odds of having perforated appendicitis (95% CI: 2.262, 13.826), a mean hospital LOS 2.047 times longer (95% CI: 1.564, 2.683), a mean time to toleration of regular diet 4.995 times longer (95% CI: 2.914, 8.918), and a mean duration of antibiotics that is 1.761 times longer (95% CI: 1.383, 2.243) than a patient with normal SIPA.
In children with appendicitis, elevated SIPA at presentation is associated with higher risk of perforation. These findings support the incorporation of SIPA during triage of patients with appendicitis and counseling families after surgery.
Level 3.
住院阑尾炎患者的住院时间（LOS）难以预测。儿童休克指数（Shock index，SIPA）可准确识别严重创伤患者，并预测入住 ICU 儿童的死亡率。本研究旨在确定就诊时升高的 SIPA 及 SIPA 恢复正常的时间能否识别穿孔性阑尾炎患儿，并预测 LOS。
这是一项回顾性队列研究，纳入 2021 年于一家四级转诊中心行阑尾切除术后诊断为阑尾炎的 1-17 岁患儿。主要结局为穿孔性阑尾炎的发生和 LOS。采用广义线性回归。所有模型中的协变量均包括年龄、性别、粪石、初始体温和从诊断到手术的时间。
共纳入 169 例患儿，53 例（31.4%）为穿孔性阑尾炎。校正后，SIPA 升高与穿孔性阑尾炎的发生（p=0.0002）和 LOS 延长（p<0.0001）相关。就诊时阑尾炎伴 SIPA 升高的患儿，发生穿孔性阑尾炎的可能性增加 5.447 倍（95%CI：2.262，13.826），住院时间延长 2.047 倍（95%CI：1.564，2.683），可耐受常规饮食的时间延长 4.995 倍（95%CI：2.914，8.918），抗生素使用时间延长 1.761 倍（95%CI：1.383，2.243）。
对于阑尾炎患儿，就诊时 SIPA 升高与穿孔风险增加相关。这些发现支持在对阑尾炎患者进行分诊时纳入 SIPA，并在手术后为患儿家属提供咨询。
3 级。
