title: Antibiotic administration can be an independent risk factor for therapeutic delay of pediatric acute appendicitis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan. nomura-o@ncchd.go.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Nomura
authors.forename: Akira
authors.initials: A
authors.lastname: Ishiguro
authors.forename: Takanobu
authors.initials: T
authors.lastname: Maekawa
authors.forename: Akira
authors.initials: A
authors.lastname: Nagai
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kuroda
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sakai
mesh_terms: D000038:Abscess / Q000453:epidemiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D001065:Appendix / Q000000981:diagnostic imaging; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D061665:Time-to-Treatment; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein