title: Clinical manifestations in children with ruptured appendicitis.
abstract: OBJECTIVE
  Appendicitis is the most common abdominal condition leading to urgent surgery in children. With the goal of identifying signs and symptoms that will allow prompt diagnosis of rupture of the appendix and thus decrease associated morbidities, our aim was to determine factors associated with ruptured appendicitis in children diagnosed with appendicitis.
  
  
  METHODS
  The medical records of children aged 17 years or younger with a postoperative diagnosis of acute appendicitis treated at Cathay General Hospital, Taipei, Taiwan, from January 2002 and May 2009, were retrospectively reviewed. The patients were divided into with and without ruptured appendicitis.
  
  
  RESULTS
  Of the 228 patients, 140 had a postoperative pathological diagnosis of a nonperforated appendix, and 88 had a diagnosis of perforated appendix, resulting in a perforation rate of 38.6%. Younger age, longer duration of abdominal pain, fever, muscle guarding, and elevated C-reactive protein level were significantly associated with a perforated appendix.
  
  
  CONCLUSIONS
  Younger age, longer duration of abdominal pain, fever, muscle guarding, and elevated C-reactive protein level are significantly associated with a perforated appendix; these factors should be closely considered in the evaluation of individuals with suspected appendicitis.
authors.affiliation: Department of Pediatrics, Song-Shan Armed Forces General Hospital, Taipei, Taiwan.
authors.forename: Min-Hsuan
authors.initials: MH
authors.lastname: Hung
authors.forename: Lung-Huang
authors.initials: LH
authors.lastname: Lin
authors.forename: Der-Fang
authors.initials: DF
authors.lastname: Chen
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D000208:Acute Disease; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D001065:Appendix; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D007902:Length of Stay; D008297:Male; D010808:Physical Examination; D012189:Retrospective Studies