Antibiotic administration can be an independent risk factor for therapeutic delay of pediatric acute appendicitis

Osamu Nomura, Akira Ishiguro, Takanobu Maekawa, Akira Nagai, Tatsuo Kuroda, Hirokazu Sakai

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

OBJECTIVES: Little is known about the relationship between prior treatment with antibiotics and delay of diagnosis and treatment in pediatric acute appendicitis (AA). We have defined a situation requiring more than 48 hours from the onset of symptoms to surgery in pediatric AA as "therapeutic delay." The aim of this study was to investigate the risk factors contributing to therapeutic delay in pediatric AA. METHODS: We conducted a retrospective chart review of AA children operated on between 2003 and 2008 at tertiary-care pediatric and perinatal hospitals. Univariate and multivariate logistic regressions were analyzed to determine independent risk factors of therapeutic delay in pediatric AA. RESULTS: The duration between the onset of symptoms and surgery was more than 48 hours (therapeutic delay) in 50 patients (25%, group A) and 48 hours or less in 151 patients (75%, group B). The patients in group A had a significantly higher frequency of diarrhea (48% vs 12%; P < 0.0001). The percentages of children who had previously received antibiotics were more frequent in group A (46% vs 8%; P < 0.0001). The median C-reactive protein levels (72 vs 7 mg/L; P < 0.0001) and frequency of perforation (60% vs 13%; P < 0.0001) were statistically significantly higher in group A. A multivariate analysis demonstrated that the independent risk factors of therapeutic delay were history of receiving antibiotics (odds ratio [OR], 5.8; 95% confidence interval [CI], 2.3-15.5), diarrhea (OR, 5.2; 95% CI, 2.1-13.1), and elevated C-reactive protein levels (OR, 4.5; 95% CI, 1.9-10.8). CONCLUSIONS: Prior treatment with antibiotics was an independent risk factor for therapeutic delay in pediatric AA.

Original languageEnglish
Pages (from-to)792-795
Number of pages4
JournalPediatric Emergency Care
Volume28
Issue number8
DOIs
Publication statusPublished - 2012 Aug 1
Externally publishedYes

Keywords

  • acute appendicitis
  • antibiotics
  • therapeutic delay

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

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