Making a Decision between Acute Appendicitis and Acute Gastroenteritis.

Yi-Ting Lu,Po-Cheng Chen,Ying-Hsien Huang,Fu-Chen Huang

doi:10.3390/children7100176

Abstract

Acute appendicitis is one of the most common pediatric abdominal emergencies. Early diagnosis is vital for a positive outcome. However, it may initially present with diarrhea and vomiting, mimicking acute gastroenteritis, thus delaying prompt surgery. Differentiating appendicitis from gastroenteritis in a timely manner poses a challenge. Therefore, we aim to investigate the predictors that help distinguish acute appendicitis from acute gastroenteritis. We conducted a retrospective case-control study, evaluating children admitted due to abdominal pain with diarrhea. Subjects were divided into two groups according to the final diagnoses: acute appendicitis and acute gastroenteritis. We adopted multiple logistic regression analysis and the area under the receiver operating characteristic curve to identify independent predictors of acute appendicitis and select the best model. A total of 32 patients diagnosed with appendicitis and 82 patients with gastroenteritis were enrolled. Five independent predictors of acute appendicitis included vomiting, right lower quadrant (RLQ) pain, stool occult blood (OB), white blood cell (WBC) count, and C-reactive protein (CRP). The revised combined model exhibited a higher degree of discrimination and outperformed the pediatric appendicitis score (PAS) model. In conclusion, our study was proved to be helpful for assessing cases with abdominal pain and diarrhea in order to more accurately distinguish appendicitis from gastroenteritis in children in a timely manner.

Highlights

Acute appendicitis in children is the most common acute surgical condition but remains a difficult diagnosis for clinicians
The purpose of this study is to identify the clinical predictors that may assist physicians in distinguishing acute appendicitis from acute gastroenteritis in children
Prior studies have indicated that the detection of appendicitis in children is often delayed due to misdiagnosis

Summary

Introduction

Acute appendicitis in children is the most common acute surgical condition but remains a difficult diagnosis for clinicians. In children, it has a higher perforation rate than in adults and may present with complicated diseases in up to 40% of cases [1]. Since enteric infections can cause appendicitis, diarrhea may be an initial manifestation, which makes gastroenteritis the assumed diagnosis [4,5,6,7]. The major factor in the delayed diagnosis of acute appendicitis is suspected gastroenteritis, which delays timely surgery [8]. Differentiating acute appendicitis and acute gastroenteritis in the early stage still poses a challenge for clinicians

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