TP9.2.19Factors Associated with Multiple Presentations Prior to Appendicectomy in Children Presenting with Suspected Appendicitis. (28th October 2021)

• Record Type: Journal Article
• Authors: Ng, James Chean Khun; Tay, Vi June; Malcolm, Francesca Ligori; Chia, Zoe; El-Sharkawy, Ahmed M; Quarmby, John
• Is Part Of: British journal of surgery. Volume 108:Supplement 7(2021)
• Publication Date: 2021-10-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab362.119
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aims: Appendicectomy is amongst the most common emergency operations in children. We aim to audit the rate of re-presentation within 30-days prior to appendicectomy in children presenting to the emergency department (ED) with suspected appendicitis and identify the factors associated with re-presentations. Methods: Retrospective review of the medical notes of all children that had an emergency appendicectomies between June 2016 and June 2019. Results: A total of 231 appendicectomies were performed, all presented through ED, with 8.2%(n = 19) re-presenting within 30-days prior to appendicectomy. Negative appendicectomy rates were similar in those that had appendectomy at initial presentation or when they re-presented (13.2(n = 28)% vs .15.8%(n = 3), p = 0.752), respectively. Of those that re-presented, 84.2%(n = 16) were not reviewed by the surgical team at the index presentation. Female patients accounted for 62.5%(n = 10) of those that re-presented, compared with 31%(n = 57) of those that presented once( p = 0.010). Pyrexia( p = 0.029), Rovsing's sign( p = 0.032), nausea or vomiting(p = 0.012) was associated with histological appendicitis. Absence of migratory pain( p = 0.005), anorexia( p = 0.004), right iliac fossa tenderness( p < 0.001) or guarding( p < 0.001) was associated with higher successful discharge rate. Among those re-presented, there was significant CRP rise between first and second presentation (median(Q1, Q3): 6(1.25, 28.5) vs .95.5(27, 176.5), p = 0.016) however, white cell count was comparable (median(Q1, Q3): 14.6(11.98, 16.05) vs .14.0(11.02, 18.58), p = 0.815). Conclusion: Clinical symptoms and signs correlated with histological appendicitis. A significant proportion of those that re-presented were not assessed by the surgical team at initial presentation. Early surgical consultation at initial presentation may reduce rates of re-presentation.