The impact of diagnostic delay on the course of acute appendicitis
BACKGROUND: The diagnosis of acute appendicitis is often delayed, which may complicate the further course of the disease. AIMS: To review appendectomy cases in order to determine the incidence of diagnostic delay, the underlying factors, and impact on the course of the disease. METHODS: Records of all children who underwent appendectomy from 1994 to 1997 were reviewed. The 129 cases were divided into group A (diagnostic period within 48 hours) and group B (diagnostic period 48 hours or more). RESULTS: In the group with diagnostic delay, significantly more children had first been referred to a paediatrician rather than to a surgeon. In almost half of the cases in this group initial diagnosis was not appendicitis but gastroenteritis. The perforation rate in group A was 24%, and in group B, 71%. Children under 5 years of age all presented in the delayed group B and had a perforation rate of 82%. The delayed group showed a higher number of postoperative complications and a longer hospitalisation period. CONCLUSIONS: Appendicitis is hard to diagnose when, because of a progressing disease process, the classical clinical picture is absent. The major factor in diagnostic delay is suspected gastroenteritis. Early surgical consultation in a child with deteriorating gastroenteritis is advised. Ultrasonographs can be of major help if abdominal signs and symptoms are non-specific for appendicitis.
|Keywords||Adolescent, Age Factors, Appendicitis/complications/*diagnosis/surgery, Child, Child, Preschool, Diagnosis, Differential, Diarrhea/etiology, Female, Gastroenteritis/diagnosis, Humans, Infant, Intestinal Perforation/etiology, Length of Stay, Male, Postoperative Complications, Prognosis, Referral and Consultation, Retrospective Studies, Rupture, Spontaneous/etiology, Time Factors|
Cappendijk, V.C., & Hazebroek, F.W.J.. (2000). The impact of diagnostic delay on the course of acute appendicitis. Archives of disease in childhood. Retrieved from http://hdl.handle.net/1765/9387