Appendicitis in Children: Does Age Really Matter?

Background: Acute appendicitis (AA) is a frequent and emergent surgical abdominal condition that presents some particularities and challenges in young children.

Patients and methods: Data of 402 children aged <16 years with a confirmed diagnosis of AA were retrospectively reviewed. Included patients were divided into two groups: Group A (preschool children aged ≤5 years, n = 44) and Group B (school children aged >5 years, n = 358). Clinical presentation, biological findings, calculated diagnosis scores (paediatric appendicitis score [PAS] and Alvarado score), intraoperative findings and outcomes were comparatively analysed between the two groups.

Results: Children of Group A had more likely fever, bowel disorders, diffuse abdominal pain and diffuse tenderness than those of Group B (P = 0.001, P = 0.005, P = 0.006 and P = 0.001, respectively). Regarding biomarkers, the mean of white blood cell count and C-reactive protein levels was higher in Group A than in Group B (18,849 cell/mm3 and 162.8 mg/L in Group A versus 15,938 cell/mm3 and 86.7 mg/L in Group B, P = 0.003 and < 0.001, respectively). The mean of calculated PAS and Alvarado scores was higher in Group A than in Group B (8.2 ± 1.1 and 8.2 ± 1 vs. 7.5 ± 1.4 and 7.4 ± 1.5, P = 0.003 and P = 0.001, respectively). Most children with a calculated PAS and Alvarado score equal to or higher than 8 belonged to Group A (PAS: 84.1% vs. 58.4%, P = 0.001, Alvarado score: 84.1% vs. 55.6%, P < 0.001). The perforation of the appendix was seen in 77.3% of Group A patients and only in 41.5% of children in Group B (P < 0.0001). The mean length of stay was 5.1 ± 1.9 days in Group A and 4.3 ± 2.8 days in Group B but without any statistical difference between the two groups (P = 0.094).

Conclusion: AA in preschool children is associated with atypical presentation and rapid progression of the disease making the early diagnosis mostly challenging in our settings.