Determination of predictive factors in the diagnosis of acute and complicated appendicitis in children

ABSTRACT DETERMINATION OF PREDICTIVE FACTORS IN THE DIAGNOSIS OF ACUTE AND COMPLICATED APPENDICITIS IN CHILDREN Objective: Acute appendicitis is the most common non-traumatic surgical emergency in children. Early diagnosis is of great importance in preventing mortality and morbidity. Our study aimed to determine predictive factors in diagnosing appendicitis and predicting complicated appendicitis in children and to evaluate the relationship between serum sodium and blood and urine ketone levels and appendicitis. Material and Method: Patients under the age of 18 who presented to Aydın Adnan Menderes University Faculty of Medicine, Pediatric Emergency Department with acute abdominal pain between April 2022 and October 2023, and whose physical examination suggested a diagnosis of appendicitis were prospectively included in the study. Demographic characteristics, symptoms, physical examination, and laboratory findings of the patients (sodium, C-reactive protein [CRP], procalcitonin [PCT], blood and urine ketone level, leukocyte, neutrophil count, etc.) were recorded. All cases were grouped as those with appendicitis and those without appendicitis at baseline. Those with appendicitis were divided into acute appendicitis (AA) and complicated appendicitis (CA). The SPSS program was used for statistical analysis. Results: 153 patients were included in the study. 100 (65%) of the patients were in the appendicitis group, and 53 (34.7%) were in the non-appendicitis group. Of the appendicitis patients, 49 (32%) had acute appendicitis, and 51 (33.3%) had complicated appendicitis. The male/female ratio in the appendicitis group was 1.9:1. The average age of patients with appendicitis was 132.3 months. There was no difference between the groups regarding age and gender (p>0.05). Pain migration, right lower quadrant tenderness, and rebound were significant positive findings in the appendicitis group (p<0.001). Leukocyte, neutrophil, CRP, blood, and urine ketone levels were significantly higher in the appendicitis group (p<0.001, p<0.001, p=0.001, p=0.03, p=0.04, respectively). CRP level was higher in CA patients compared to AA patients (p<0.001), and there was no significant difference in leukocyte and neutrophil levels. While leukocytes (p=0.013), neutrophils (p=0.014), and blood ketone (p=0.035) were significantly higher in the appendicitis group among patients with symptom duration less than 24 hours, leukocytes (p=0.005), neutrophils (p=0.001), CRP (p=0.001) were significantly higher and sodium (p=0.046) were significantly lower in patients with appendicitis among patients with symptom duration more than 24 hours. Conclusion: In our study, ketone levels, in addition to CRP, leukocyte, and neutrophil counts in appendicitis patients, were statistically significantly higher, consistent with our hypothesis. It was observed that the blood ketone level was significant, especially in the early presentation of appendicitis, and the increase in CRP and low sodium became significant as the duration of admission to the hospital increased. Because acute appendicitis is common in children and still causes high morbidity, it is thought that new studies are needed to determine predictive factors in predicting appendicitis. Key Words: Appendicitis, Emergency, Child, Sodium, Ketone