STUDY TO DETERMINE THE CAUSES OF LATE REFERRALS AND OUTCOME OF APPENDICITIS IN CHILDREN

Objectives: The incidence of appendicitis is increasing in developing countries. Our goal was to determine the impact of late referrals and inappropriate treatment on the outcome of appendicitis among children.

Place and Duration: This Retrospective Study was held in the Pediatric Surgery department of Nishtar Hospital Multan for one-year duration from April 2019 to April 2020

Methodology: Retrospective analysis of all children treated for appendicitis were selected. Pre- and post-operative diseases, length of hospitalization, treatment costs and mortality were compared among children who presented early, within 24 hours of the first episode of symptoms and those onwards.

Results: A total of 481 children aged 2 to 16 years (mean 9.7 ± 2.8), including 265 men and 216 women with a male to female ratio of 1.2: 1, had appendectomy, which was 5.7 % of all pediatric operations and 47.5% of all abdominal operations in children. Only 206 (42.8%) children reported in the first episode of symptoms and in a clinically stable condition, and 275 (57.2%) were referred after poor diagnosis and treatment by family doctors, which resulted in various complications from appendicitis 60 (12 , 5%), appendix weight 54 (11.2%), perforated appendix 47 (9.8%), gangrene of the appendix 41 (8.5%), and peritonitis 34 (7.0%). These influenced the postoperative outcome with wound infection reported in 91 (18.9%), wound fracture 35 (7.3%), sepsis 31 (6.4%), pelvic abscess 13 (2.7%) and death 1 (0.2%). They were not reported among those who reported early, who also had significantly shorter hospitalization and treatment costs (P <0.0001).

Conclusion: Late referrals due to a low rate of suspicion were common, which significantly increased associated diseases and mortality among children treated with appendicitis.

Keywords: appendicitis, children, incidence, outcome, developing country.