infection presenting as pseudo-appendicitis in children: identifying predictors for early diagnosis.

AIMS

To characterize enteritis presenting as pseudo-appendicitis and identify distinguishing predicting factors.

METHODS

This retrospective multicentre study included all children <18 years with confirmed infection, hospitalized from 2014 to 2023 for presumed appendicitis (pseudo-appendicitis group). Each case was matched with 2 controls with confirmed appendicitis. Multivariable logistic regression analysis was conducted to determine the potential predictors for pseudo-appendicitis.

RESULTS

Fifty-five cases of pseudo-appendicitis were compared with 110 cases of appendicitis. The rate of peritoneal signs was similar between the two groups (78.2% vs. 75.5%,  = 0.07). Computed-tomography (CT) scans were performed nearly twice as often in the pseudo-appendicitis group (38% vs. 20%,  = 0.01). Broad-spectrum antibiotics were administered to 19 (34.5%) of patients with pseudo-appendicitis and none had surgery. Independent predictors of pseudo-appendicitis included: history of fever (OR: 17.2, 95% CI: 4.7-62.9,  < 0.01), WBC <12,000/l (OR: 9.6, 95% CI: 2.9-31,  < 0.01), sonographic signs of enlarged mesenteric lymphadenopathy and/or ileocolitis (OR:5.8, 95% CI:1.8-18.6,  = 0.03), no sonographic sign of appendicitis (OR: -5.8, 95% CI: 1.3-25,  = 0.02), diarrhea (OR: 3.7, 95% CI:1.2-11.3,  = 0.02), and age >14 years (OR:3.3, 95% CI:0.91-12,  = 0.06).

CONCLUSION

The diagnostic challenge of pseudo-appendicitis notably led to high rates of CT imaging and unnecessary broad-spectrum antibiotic administration. We identified predictors that may prompt clinicians to consider enteritis in selected cases of suspected appendicitis, potentially encouraging early molecular diagnosis and improving patient care.