Advertisement

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

  • Meredith C. ThompsonEmail author
  • David Carlberg
Chapter

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.

Keywords

Appendicitis Child Children Pediatric Right lower quadrant Fever Pediatric Appendicitis Score Ultrasound CT MRI 

References

  1. 1.
    Bundy DG, Byerley JS, Liles EA, Perring EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;298(4):438–51.CrossRefGoogle Scholar
  2. 2.
    Becker T, Kharbanda A, Bachur R. Atypical clinical features of pediatric appendicitis. Acad Emerg Med. 2007;14(2):124–9.CrossRefGoogle Scholar
  3. 3.
    Rothrock SG, Skeoch G, Rush JJ, Johnson NE. Clinical features of misdiagnosed appendicitis in children. Ann Emerg Med. 1991;20(1):45–50.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.PubMedGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 8.
    Kharbanda AB. Appendicitis: do clinical scores matter? Ann Emerg Med. 2014;64(4):373–5.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 18.
    Bachur RG, Lipsett SC, Monuteaux MC. Outcomes of nonoperative management of uncomplicated appendicitis. Pediatrics. 2017;140(1):e20170048.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Department of Emergency MedicineMedStar Georgetown University Hospital & Washington Hospital CenterWashington, DCUSA

Personalised recommendations