Appendiceal perforation in children diagnosed in a pediatric emergency department

Objective: To determine the incidence of appendiceal perforation (AP) among children with acute appendicitis (AA) and determine factors associated with AP. Design: Retrospective chart review. Setting: Emergency department (ED) of Primary Children's Medical Center (PCMC). Patients: 131 children less than 17 years of age with AA diagnosed in the PCMC ED. Results: The overall rate of AP was 47%. One hundred eleven (85%) children with AA were correctly diagnosed on their first ED visit. Patients with AP had a significantly (P < 0.05) lower median age (8.0 vs 11.0 gears), longer duration of illness (3.0 vs 1.4 days), greater incidence of vomiting and fever by history (91% vs 69% and 83% vs 58%, respectively), higher median temperatures (39.0 degrees vs 38.3 degrees C), and higher proportions of leukocyte (WBC) band forms (14% vs 5%). Patients with AP did not differ from those without AP with respect to total WBC count, hour of arrival, or number of ED visits. Conclusions: The rate of AP among pediatric patients with AA is greater among younger children and is associated with vomiting, prolonged illness, and higher body temperatures. Unexpectedly, patients with AP did not have higher total WBC values, more frequent late night arrivals, a longer time interval prior to surgery, or more ED visits prior to diagnosis. These findings suggest that efforts to decrease the rate of AP should be directed toward heightening awareness among primary care physicians regarding the high rate of AP in children, with an emphasis on early ED and surgical referral.