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Predictive factors for perforated appendicitis in a pediatric population treated at a referral hospital in Bogotá D.C., Colombia
Factores predictores de apendicitis perforada en población pediátrica de un hospital de referencia en Bogotá D.C., Colombia
Palabras clave:
Appendicitis, Pediatrics, Spontaneous Perforation, Risk factors (en)Apendicitis, Pediatría, Perforación espontánea, Factores de riesgo (es)
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Introduction: Acute appendicitis is the leading cause of abdominal surgical emergencies in pediatrics. Between 30% and 75% of cases progress to perforated appendicitis; however, timely diagnosis before perforation occurs remains a challenge.
Objective: To identify predictive factors for perforated appendicitis in a pediatric population (<18 years) at the time of admission to the emergency department.
Materials and methods: Prospective cohort study conducted in 193 patients (perforated appendicitis=98; non-perforated appendicitis=95) admitted to the emergency department of a pediatric referral hospital in Bogotá D.C., or referred to such hospital, who underwent appendectomy between November 1 and December 31, 2013. Bivariate analyses were performed (Student's t-tests, Mann-Whitney U, chi-square or Fisher's exact), calculating the odds ratios (OR) with their respective 95%CI. In the multivariate analysis (logistic regression), the stepwise regression method was used to select variables according to their statistical significance, and regression models were performed. The explanatory power of the models was verified by calculating the areas under the ROC curve.
Results: The mean age of the participants was 9.8 years, and the prevalence of perforated appendicitis was 50.78%. The following predictive factors for perforated appendicitis were identified in the multivariate analysis: presence of emesis on admission to the emergency department (OR=4.28, 95%CI: 1.63-11.21), presence of tachycardia on physical examination (OR=3.38, 95%CI:1.69-6.59), temperature >38.3°C on physical examination (OR=3.36, 95%CI: 1.29-8.70), and duration of symptoms until surgery (OR=1.95, 95%CI: 1.37-2.77).
Conclusions: In the present study, duration of symptoms until surgery, presence of emesis during questioning on admission to the emergency department, and presence of tachycardia and fever (>38.3°) on physical examination behaved as predictive factors for acute perforated appendicitis in pediatric patients.
Introducción. La apendicitis aguda es la principal causa de urgencia quirúrgica abdominal en población pediátrica. Entre 30% y 75% de los casos progresan a apendicitis perforada; sin embargo, el diagnóstico oportuno de esta condición antes de que ocurra la perforación continúa siendo un reto.
Objetivo. Identificar los factores predictores de apendicitis perforada en población pediátrica (<18 años) al momento de ingreso al servicio de urgencias.
Materiales y métodos. Estudio de cohortes prospectivo realizado en 193 pacientes (apendicitis perforada=98; no perforada=95) admitidos al servicio de urgencias de un hospital pediátrico de referencia en Bogotá D.C., Colombia, o remitidos a dicho hospital y a los que se les realizó apendicectomía entre noviembre 1 y diciembre 31 de 2013. Se realizaron análisis bivariados (pruebas t-Student, U de Mann-Whitney, chi cuadrado o exacta de Fisher), calculando Odds ratio (OR) con sus respectivos IC95%. En el análisis multivariado (regresión logística) se utilizó el método de regresión paso a paso para seleccionar las variables según su significancia estadística y se realizaron modelos de regresión. La capacidad de explicación de los modelos se verificó con el cálculo de áreas bajo la curva ROC.
Resultados. La edad promedio de los participantes fue 9.8 años y la prevalencia de apendicitis perforada fue 50.78%. En el análisis multivariado se identificaron los siguientes factores predictores para apendicitis perforada: presencia de vómito en el interrogatorio al ingreso a urgencias (OR=4.28, IC95%: 1.63-11.21), presencia de taquicardia en el examen físico (OR=3.38, IC95: 1.69-6.59), temperatura >38.3ºC en el examen físico (OR=3.36, IC95%: 1.29-8.70) y la duración de los síntomas hasta la cirugía (OR=1.95, IC95%: 1.37-2.77).
Conclusiones. En este estudio, la duración de los síntomas hasta la cirugía, la presencia de vómito en el interrogatorio al ingreso a urgencias y la presencia de taquicardia y de fiebre (>38.3°C) al examen físico se comportaron como factores predictores de apendicitis aguda perforada en pacientes pediátricos.
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Obinwa O, Peirce C, Cassidy M, Fahey T, Flynn J. A model predicting perforation and complications in paediatric appendicectomy. Int J Colorectal Dis. 2015;30(4):559-65. https://doi.org/kqg4.
Yang J, Liu C, He Y, Cai Z. Laboratory Markers in the Prediction of Acute Perforated Appendicitis in Children. Emerg Med Int. 2019;2019:4608053. https://doi.org/kqg6.
Akhtar-Danesh GG, Doumouras AG, Flageole H, Hong D. Geographic and socioeconomic predictors of perforated appendicitis: A national Canadian cohort study. J Pediatr Surg. 2019;54(9):1804-8. https://doi.org/grdfsg.
Miyauchi H, Okata Y, Hatakeyama T, Nakatani T, Nakai Y, Bitoh Y. Analysis of predictive factors for perforated appendicitis in children. Pediatr Int. 2020;62(6):711-5. https://doi.org/kqmz.
Bonadio W, Peloquin P, Brazg J, Scheinbach I, Saunders J, Okpalaji C, et al. Appendicitis in preschool aged children: Regression analysis of factors associated with perforation outcome. J Pediatr Surg. 2015;50(9):1569-73. https://doi.org/f7rhz5.
Garcés-Martínez AF. Detección de los factores de riesgo para la presencia de apendicitis aguda perforada en la población pediátrica [thesis]. Bogotá D.C.: Facultad de Medicina, Universidad Nacional de Colombia; 2014.
Rodríguez E, Valero J, Jaramillo L, Vallejo-Ortega MT, Lagos L. Evaluation of concordance among surgeons and pathologists regarding the diagnosis and classification of acute appendicitis in children. J Pediatr Surg. 2020;55(8):1503-6. https://doi.org/kqm2.
St. Peter SD, Sharp SW, Holcomb GW, Ostlie DJ. An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg. 2008;43(12):2242-5. https://doi.org/dnnqh4.
Castañeda-Espinosa SD, Molina-Ramírez I, Holguín-Sanabria A, Jaimes-de La Hoz P, Perilla-López M, Pedraza-Carvajal A, et al. Cambio en la clasificación macroscópica de la apendicitis. ¿Tiene algún impacto? Estudio retrospectivo en un Hospital Universitario Pediátrico. Rev. Fac. Med. 2015;63(2):243-50. https://doi.org/kqm3.
Colombia. Departamento Administrativo Nacional de Estadística D (DANE). Estratificación Socioeconómica - Preguntas frecuentes. Bogotá D.C.: DANE; 2016 [cited 2023 Aug 23]. Available from: https://bit.ly/3QR4pqc.
Valero J, Buitrago G, Eslava-Schmalbach J, Rincon CJ. Prognostic Factors Associated with Clinical and Economic Outcomes of Appendectomies in Children: A Multilevel Analysis in a National Retrospective Cohort Study. World J Surg. 2020;44(1):303-12. https://doi.org/kqm4.
World Medical Association (WMA). WMA Declaration of Helsinki – Ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013.
Colombia. Ministerio de Salud. Resolución 8430 de 1993 (octubre 4): Por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud. Bogotá D.C.; october 4 1993.
Papandria D, Goldstein SD, Rhee D, Salazar JH, Arlikar J, Gorgy A, et al. Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J Surg Res. 2013;184(2):723-9. https://doi.org/f49565.
Zvizdic Z, Golos AD, Milisic E, Jonuzi A, Zvizdic D, Glamoclija U, et al. The predictors of perforated appendicitis in the pediatric emergency department: A retrospective observational cohort study. Am J Emerg Med. 2021;49:249-52. https://doi.org/kqmf.
Ngim CF, Quek KF, Dhanoa A, Khoo JJ, Vellusamy M, Ng CS. Pediatric appendicitis in a developing country: What are the clinical predictors and outcome of perforation? J Trop Pediatr. 2014;60(6):409-14. https://doi.org/f6r89t.
Trent SA, Valley MA, Brookler K, Haukoos JS, Zerzan JT. Potential barriers associated with increased prevalence of perforated appendicitis in Colorado’s pediatric Medicaid population. Am J Emerg Med. 2013;31(3):469-72. https://doi.org/f4sqvp .
Singh M, Kadian YS, Rattan KN, Jangra B. Complicated appendicitis: Analysis of risk factors in children. Afr J Paediatr Surg. 2014;11(2):109-13. https://doi.org/kqm5.
Putnam LR, Tsao K, Nguyen HT, Kellagher CM, Lally KP, Austin MT. The Impact of Socioeconomic Status on Appendiceal Perforation in Pediatric Appendicitis. J Pediatr. 2016;170:156-160.e1. https://doi.org/f8b6fs .
Schwartz K, Nguyen M. Spatial-temporal clusters of pediatric perforated appendicitis in California. J Pediatr Surg. 2021;56(6):1208-13. https://doi.org/kqm6.
Bonadio W, Shahid S, Vardi L, Buckingham C, Kornblatt A, Free C, et al. A pre-operative clinical scoring system to distinguish perforation risk with pediatric appendicitis. J Pediatr Surg. 2018;53(3):441-5. https://doi.org/kqm7.
Bonadio W, Brazg J, Telt N, Pe M, Doss F, Dancy L, et al. Impact of In-Hospital Timing to Appendectomy on Perforation Rates in Children with Appendicitis. J Emerg Med. 2015;49(5):597-604. https://doi.org/f723td.
Meltzer JA, Kunkov S, Chao JH, Tay ET, George JP, Borukhov D, et al. Association of Delay in Appendectomy With Perforation in Children With Appendicitis. Pediatr Emerg Care. 2019;35(1):45-9. https://doi.org/kqmq.
Yoon HM, Kim JH, Lee JS, Ryu JM, Kim DY, Lee JY. Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and a high risk of perforation. World J Pediatr. 2018;14(2):184-90. https://doi.org/kqm9.
Lopez-Castillo H, Policart RA, Wong M. Factores de riesgo asociados a la apendicitis aguda perforada. Pediátri Panamá. 2011;40(2):12-9.
Peter S, Wester T. Capítulo 42: Appendicitis. In: Holcomb GW, Murphy JP, St Peter SD, editors. Holcomb and Ashcraft`s Pediatric surgery. 7th ed. Elsevier; 2020.
Stevenson MD, Dayan PS, Dudley NC, Bajaj L, Macias CG, Bachur RG, et al. Time from emergency department evaluation to operation and appendiceal perforation. Pediatrics. 2017;139(6) :e20160742. https://doi.org/gbjbt4.
Pham XBD, Sullins VF, Kim DY, Range B, Kaji AH, de Virgilio CM, et al. Factors predictive of complicated appendicitis in children. J Surg Res. 2016;206(1):62-6. https://doi.org/f9cd3f.
Castro P, Rincón J, Sánchez C, Molina I, Buitrago G. Presurgical time and associated factors as predictors of acute perforated appendicitis: a prospective cohort study in a teaching pediatric hospital in Colombia. BMC Pediatr. 2022;22(1):49. https://doi.org/kqnb.
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