J Korean Soc Emerg Med.  2023 Dec;34(6):615-621.

A study of predictive factors that can consider surgical treatment when the imaging findings are non-diagnostic for diagnosis of pediatric appendicitis

• Choi S
• Kim Y
• Jeong R
• Lee KH
• Yu W
• Yoon Y
• Kwak K
• Chung SY

Abstract

Objective
This study examined the predictive factors to decide the surgical treatment for clinically suspected pediatric acute appendicitis with equivocal imaging findings.
Methods
This study was conducted retrospectively on children who visited local emergency medical centers and outpatients from January 2018 to February 2021. The electronic medical records were reviewed from 811 pediatric patients younger than 16 years of age with the chief complaint of abdominal pain and who underwent an imaging test for the clinical suspicion of appendicitis. Ninety-two patients who showed ambiguous findings on imaging tests but were still suspected of having appendicitis were analyzed. Recursive partitioning analysis and multivariable logistic regression were used to identify the variables associated with appendicitis.
Results
Of the 92 enrolled patients, 23 patients were confirmed to have appendicitis, and 69 did not. Patients with the clinical suspicion who had an elevated white blood cell (WBC) count, polymorphonuclear leukocyte differential count (PMN), absolute neutrophil count (ANC), and leukocytosis were more likely to have appendicitis. The PMN (odds ratio=1.175; 95% confidence interval, 1.092-1.265) and ANC (odds ratio=1.00050; 95% confidence interval, 1.00025-1.00075) remained significant after multivariable logistic analysis.
Conclusion
Elevated PMN and ANC are clinical predictors of pediatric appendicitis when the imaging findings are nondiagnostic, and the clinical suspicion is continuous.

Keyword

Appendicitis; Pediatrics; Ultrasonography; Acute abdomen