Trends in diagnostic approaches for pediatric appendicitis: nationwide population-based study

BMC Pediatrics

Research Article

Wen-Kuei Chien¹  Hung-Chang Huang²  Ray-Jade Chen³  Hung-Chieh Lo⁴  Sheng-Mao Wu⁵  Hsun-Chin Chao⁶  Chen-Sheng Huang⁷  Chih-Cheng Luo⁸ 

[1]Biostatistics Center, Taipei Medical University, Taipei City, Taiwan

[2]Department of Acute Care Surgery and Traumatology, Taipei Medical University Hospital, Taipei City, Taiwan

[3]Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan

[4]Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan

[5]Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan

[6]Department of Traumatology, Wan Fang Hospital, Taipei City, Taiwan

[7]Department of Traumatology, Wan Fang Hospital, Taipei City, Taiwan

[8]Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Guishan Dist, 33305, Taoyuan City, Taiwan

[9]Division of Pediatric Surgery, Department of Surgery, Wan Fang Hospital, Taipei City, Taiwan

[10]Division of Pediatric Surgery, Department of Surgery, Wan Fang Hospital, Taipei City, Taiwan

[11]Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan

关键词: Appendicitis;    Ultrasound;    Computed tomography;    National Health Insurance Database;   

DOI  :  10.1186/s12887-017-0940-7

 received in 2016-04-18, accepted in 2017-10-30,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundTo define the benefits of different methods for diagnosis of pediatric appendicitis in Taiwan, a nationwide cohort study was used for analysis.MethodsWe identified 44,529 patients under 18 years old who had been hospitalized with a diagnosis of acute appendicitis between 2003 and 2012. We analyzed the percentages of cases in which ultrasound (US) and/or computed tomography (CT) were performed and non-perforated and perforated appendicitis were diagnosed for each year. Multivariate logistic regression analyses were performed to evaluate risk factors for perforated appendicitis.ResultsThere were more cases of non-perforated appendicitis (N = 32,491) than perforated appendicitis (N = 12,038). The rate of non-perforated cases decreased from 0.068% in 2003 to 0.049% in 2012; perforated cases remained relatively stable at 0.024%~0.023% from 2003 to 2012. The percentage of CT evaluation increased from 3% in 2003 to 20% in 2012; the rates of US or both US and CT evaluations were similar annually. The percentage of neither CT nor US evaluation gradually decreased from 97% in 2003, to 79% in 2012. The odds ratios of a perforated appendix for those patients diagnosed by US, CT, or both US and CT were 1.227 (95% confidence interval (CI) 0.91, 1.65; p = 0.173), 2.744 (95% CI 2.55, 2.95; p < 0.001), and 5.062 (95% CI = 3.14, 8.17; p < 0.001), respectively, compared to patients who did not receive US or CT. The odd ratios of a perforated appendix for those patients 7–12 and ≤6 years old were 1.756 (95% CI 1.67, 1.84; p < 0.001) and 3.094 (95% CI 2.87, 3.34; p < 0.001), respectively, compared to those 13–18 years old.ConclusionsOur study demonstrated that using CT scan as a diagnostic tool for acute appendicitis increased annually; most patients especially those ≤6 years old who received CT evaluation had a greater risk of having perforated appendicitis. We recommend a prompt appendectomy in those pediatric patients with typical clinical symptoms and physical findings for non-complicated appendicitis to avoid the risk of appendiceal perforation.

【 授权许可】

CC BY   
© The Author(s). 2017