Skip to main content
SpringerLink
Log in

What About Kids and Appendicitis? Small Adults or Different Approach?

  • Chapter
  • First Online:
Gastrointestinal Emergencies

  • 85 Accesses

Abstract

Appendicitis diagnosis in children is challenging. Atypical features are common. Less than half of children will present with classic periumbilical pain migrating to the right lower quadrant. Misdiagnosis rates are high. Perforation risk rises linearly and substantially with time. Clinical decision rules have been developed to aid in diagnosis but have limited utility due to inadequate positive predictive value. Ultrasound is the preferred initial imaging modality in children. Transfer to a pediatric center should be considered before imaging is conducted due to the complex clinical decision-making that may occur with an equivocal ultrasound. Appendectomy is the mainstay of treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bundy DG, Byerley JS, Liles EA, Perring EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;298(4):438–51.

    Article  CAS  Google Scholar 

  2. Becker T, Kharbanda A, Bachur R. Atypical clinical features of pediatric appendicitis. Acad Emerg Med. 2007;14(2):124–9.

    Article  Google Scholar 

  3. Rothrock SG, Skeoch G, Rush JJ, Johnson NE. Clinical features of misdiagnosed appendicitis in children. Ann Emerg Med. 1991;20(1):45–50.

    Article  CAS  Google Scholar 

  4. Narsule CK, Kahle EJ, Kim DS, Anderson AC, Luks FI. Effect of delay in presentation on rate of perforation in children with appendicitis. Am J Emerg Med. 2011;29(8):890–3.

    Article  Google Scholar 

  5. Selbst SM, Friedman MJ, Singh SB. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers. Pediatr Emerg Care. 2005;21(3):165–9.

    PubMed  Google Scholar 

  6. Mandeville K, Pottker T, Bulloch B, Liu J. Using appendicitis scores in the pediatric ED. Am J Emerg Med. 2011;29(9):972–7.

    Article  Google Scholar 

  7. Ebell MH, Shinholser J. What are the most clinically useful cutoffs for the alvarado and pediatric appendicitis scores? A systematic review. Ann Emerg Med. 2014;64(4):365–72.

    Article  Google Scholar 

  8. Kharbanda AB. Appendicitis: do clinical scores matter? Ann Emerg Med. 2014;64(4):373–5.

    Article  Google Scholar 

  9. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, Babyn PS, Dick PT. US or CT for diagnosis of appendicitis in children and adults? A Meta-Analysis. Radiology. 2006;241(1):83–94.

    Article  Google Scholar 

  10. Rice HE, Frush DP, Farmer D, Waldhausen JH, APSA Education Committee. Review of radiation risks from computed tomography: essentials for the pediatric surgeon. J Pediatr Surg. 2007;42(4):603–7.

    Article  Google Scholar 

  11. Smith MP, Katz DS, Lalani T, Carucci LR, Cash PD, Kim DH, Piorkowski RJ, Small WC, Spottswood SE, Tulchinski M, Yaghmai V, Yee J, Rosen MP. ACR appropriateness criteria® right lower quadrant pain--suspected appendicitis. Ultrasound Q. 2015;31(2):85–91.

    Article  Google Scholar 

  12. Pacham P, Ying J, Linam LE, Brody AS, Babcock DS. Sonography in the evaluation of acute appendicitis: are negative sonographic findings good enough? J Ultrasound Med. 2010;29(12):1749–55.

    Article  Google Scholar 

  13. Trout AT, Sanchez R, Ladino-Torres MF, et al. A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography? Pediatr Radiol. 2012;42:813–23.

    Article  Google Scholar 

  14. D’Souza N, D’Souza C, Grant D, et al. The value of ultrasonography in the diagnosis of appendicitis. Int J Surg. 2015;13:165–9.

    Article  Google Scholar 

  15. Ross MJ, Liu H, Netherton SJ, Eccles R, et al. Outcomes of children with suspected appendicitis and incompletely visualized appendix on ultrasound. Acad Emerg Med. 2014;21:538–42.

    Article  Google Scholar 

  16. Kim JR, Suh CH, Yoon HM, Jung AY, Lee JS, Kim JH, Lee JY, Cho YA. Performance of MRI for suspected appendicitis in pediatric patients and negative appendectomy rate: a systematic review and meta-analysis. J Magn Reson Imaging. 2018;47(3):767–78.

    Google Scholar 

  17. Badru F, Piening N, To A, Xu P, Fitzpatrick C, Chatoorgoon K, Villalona G, Greespon J. Imaging for acute appendicitis at non-pediatric centers exposes children to excess radiation. J Surg Res 2017;216:201–06.

    Google Scholar 

  18. Bachur RG, Lipsett SC, Monuteaux MC. Outcomes of nonoperative management of uncomplicated appendicitis. Pediatrics. 2017;140(1):e20170048.

    Google Scholar 

  19. Georgiou R, Eaton S, Stanton MP, et al. Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis. Pediatrics. 2017;139(3):e20163003.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA

    Meredith C. Thompson

  2. Department of Emergency Medicine, MedStar Georgetown University Hospital & Washington Hospital Center, Washington, DC, USA

    David Carlberg

Authors
  1. Meredith C. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Carlberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meredith C. Thompson .

Editor information

Editors and Affiliations

  1. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA

    Autumn Graham

  2. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA

    David J. Carlberg

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Thompson, M.C., Carlberg, D. (2019). What About Kids and Appendicitis? Small Adults or Different Approach?. In: Graham, A., Carlberg, D.J. (eds) Gastrointestinal Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-98343-1_79

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98343-1_79

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98342-4

  • Online ISBN: 978-3-319-98343-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation