An Evidence-Based Review Of Acute Appendicitis In Childhood

The special diagnostic challenges of appendicitis in children, along with the greater dangers of misdiagnosis, delay, and perforation, make swift and accurate diagnosis of appendicitis essential for emergency clinicians. Appendicitis is the most common indication for abdominal surgery in children presenting to the emergency department. Because of the frequently atypical presentation of appendicitis in children, delayed diagnosis is common, affecting as many as 57% of cases of appendicitis in children under 6 years of age. Although the risk decreases with age, perforation has been reported in more than 70% of children in the first 4 years of life at the time of surgery. Because the differential diagnosis for right-lower-quadrant pain in pediatric patients is so extensive, this review notes how signs and symptoms can vary by age group. A discussion of how a detailed, age-appropriate history can help guide the emergency clinician in determining diagnostic strategies is reviewed. Evidence regarding the choices of radiologic studies for children, including ultrasound and computed tomography, is presented, along with prophylactic antibiotics, pain medication, and the benefits of early surgical consult.