Document Detail

Appendicitis in children: a continuing clinical challenge.
MedLine Citation:
PMID:  1404459     Owner:  NLM     Status:  MEDLINE    
This article discusses the findings of a study of pre-adolescent children to determine if the mode of presentation of appendicitis had changed over the past 10 years, if the incidence of perforations decreased with age, and if diagnosis related groups (DRGs) impacted the length of hospital stay. The charts of 42 children under the age of 12 years who were discharged from two inner-city hospitals with a diagnosis of acute appendicitis from 1980 to 1989 were reviewed. There were 20 blacks and 22 whites, 26 males and 16 females with an average age of 7.31 years (range: 2 to 11 years). Over 95% of patients presented with right lower quadrant pain, 78% with guarding, 80% with a positive psoas sign, 93% with a positive Rovsing's sign, and 65% with rectal tenderness. Over 85% of patients had a history of nausea, vomiting, and anorexia. The mean duration of pain was 52.8 hours and the mean temperature was 99.6 degrees F. The mean white blood cell count was 18,176 +/- 4682 for whites versus 14,615 +/- 5459 for blacks. At surgery 15/42 (36%) of patients had a perforation, 11 of whom had positive wound cultures. Escherichia coli was recovered in all 11 of these patients. The average duration of pain in the perforated group was 50.9 hours, and the average age was 7 years. Eleven of these patients had normal bowel sounds on admission. Only 31% of the total cohort had a fecalith identified by pathology. The average postoperative length of stay was 6.5 +/- 2.5 days before the initiation of DRGs and 7.5 +/- 3 days afterward.
R R Marrero; S Barnwell; E L Hoover
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the National Medical Association     Volume:  84     ISSN:  0027-9684     ISO Abbreviation:  J Natl Med Assoc     Publication Date:  1992 Oct 
Date Detail:
Created Date:  1992-11-23     Completed Date:  1992-11-23     Revised Date:  2010-09-07    
Medline Journal Info:
Nlm Unique ID:  7503090     Medline TA:  J Natl Med Assoc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  850-2     Citation Subset:  IM    
Department of Surgery, Meharry Medical College, Nashville, Tennessee.
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MeSH Terms
Appendicitis / diagnosis,  epidemiology*
Child, Preschool
Diagnosis-Related Groups
Intestinal Perforation / diagnosis,  epidemiology*
Length of Stay / trends
Poverty Areas
Rupture, Spontaneous
Tennessee / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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