Appendicitis (peds)

Background

• most common between 6-14 yrs (peak 9y-12y), 6% of pop., d/t lumen of appy obst= inflamm= later perf, perf rate up to 92% in children <3 yrs old!

Diagnosis

Likelihood Ratios

In children with abdominal pain:

Sx +LR -LR Fever 3.4 Rebound 3.0 0.28 Migration 2.5 1.2 WBC <10k 0.22 ANC <6,750 0.06

S/S in children <2 can be vague (vomiting 85-90%, pain 35-77%, diarrhea 18-46%, fever 40-60%, irritability, refusal to walk, limp, inc resp rate, grunting, anorexia is seen in 50% of >12 y/o, 20% will have nl WBC, UA may hve some RBC/WBC usu not too high

reynolds 'peds emergcare 1992' found 97% of pts w/ appy had 2/4-prosp eval of 377 children age 2-16, appendicitis in 8%, 97% of pts (2y-16y) with appy had 2/4 of vomiting, guarding, TTP, RLQ pain, 28% w/o appy had these. (PPV=24% NPV=99%)

See Also

Peds: Abdominal Pain (Peds)

Source

Bundy DG et al. Does this child have appendicitis? JAMA 2007; 298:438-451