title: Effect of delay in presentation on rate of perforation in children with appendicitis.
abstract: BACKGROUND
  Appendicitis is the most common emergency operation in children. The rate of perforation may be related to duration from symptom onset to treatment. A recent adult study suggests that the perforation risk is minimal in the first 36 hours and remains at 5% thereafter. We studied a pediatric population to assess symptom duration as a risk factor for perforation.
  
  
  METHODS
  We prospectively studied all children older than 3 years who underwent an appendectomy over a 22-month period.
  
  
  RESULTS
  Of 202 patients undergoing appendectomies, 197 had appendicitis. Median age was significantly lower in the perforated group, but temperature and leukocytosis were not. As expected, length of hospital stay was longer in the perforated group (4-13 vs 2-6 days). The incidence of perforation was 10% if symptoms were present for less than 18 hours. This incidence rose in a linear fashion to 44% by 36 hours. Prehospital delays were greater in patients with perforated appendicitis. However, in-hospital delay (from presentation to surgery) was less than 5 hours in the perforated group and 9 hours in the nonperforated group.
  
  
  CONCLUSIONS
  Appendiceal perforation in children is more common than in adults and correlates directly with duration of symptoms before surgery. Perforation is more common in younger children. Unlike in adults, the risk of perforation within 24 hours of onset is substantial (7.7%), and it increases in a linear fashion with duration of symptoms. In our experience, however, perforation correlates more with prehospital delay than with in-hospital delay.
authors.affiliation: Division of Pediatric Surgery, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02905, USA.
authors.forename: Chaitan K
authors.initials: CK
authors.lastname: Narsule
authors.forename: Eden J
authors.initials: EJ
authors.lastname: Kahle
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Kim
authors.forename: Angela C
authors.initials: AC
authors.lastname: Anderson
authors.forename: Francois I
authors.initials: FI
authors.lastname: Luks
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors