title: Pediatric appendicitis in a developing country: what are the clinical predictors and outcome of perforation?
abstract: OBJECTIVE
  This study explored the risk factors and outcomes associated with perforation in children who underwent emergency appendicectomies.
  
  
  METHODS
  A retrospective cross-sectional study was conducted on children <13 years old who underwent appendicectomies in a Malaysian hospital in 2007.
  
  
  RESULTS
  One hundred thirty-four children underwent appendicectomies of which 118 were confirmed histologically. Sixty-one (52%) were perforated. Children with perforation had significantly longer duration of symptoms (p < 0.001), higher white cell count and absolute neutrophil counts (p = 0.013), with longer intra-operative period (p < 0.001) and post-operative recovery period (p < 0.001). Of the 52 samples of pus collected intra-operatively, 37 (71.1%) yielded positive cultures that were predominantly Escherichia coli (n = 27). Both the patients who had Staphylococcus aureus cultured from pus collected intra-operatively had significant pyogenic complications (scrotal pyocele and intra-abdominal abscess).
  
  
  CONCLUSIONS
  Children whose appendicitis were perforated had longer duration of symptoms, higher white cell counts and absolute neutrophil counts. Those with S.aureus cultured from intra-operative pus appeared to suffer more complications.
authors: Department of Pediatrics, Johor Bahru Clinical School, Monash University Malaysia, 80100 Johor Bahru, Malaysia ngim.chin.fang@monash.edu.
authors: Chin Fang
authors: CF
authors: Ngim
authors: School of Medicine & Health Sciences, Monash University Malaysia, 46150 Selangor, Malaysia.
authors: Kia Fatt
authors: KF
authors: Quek
authors: Department of Microbiology, Monash University Malaysia, 46150 Selangor, Malaysia.
authors: Amreeta
authors: A
authors: Dhanoa
authors: Department of Pathology, Johor Bahru Clinical School, Monash University Malaysia, 80100 Johor Bahru, Malaysia.
authors: Joon Joon
authors: JJ
authors: Khoo
authors: Department of Surgery, Sultanah Aminah Hospital, Jalan Persiaran Abu Bakar Sultan, Johor Bahru, 80100 Johor, Malaysia.
authors: Muthualhagi
authors: M
authors: Vellusamy
authors: Department of Nuclear Medicine, Sultanah Aminah Hospital, Jalan Persiaran Abu Bakar Sultan, Johor Bahru, 80100 Johor, Malaysia.
authors: Chen Siew
authors: CS
authors: Ng
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology*; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology; D007902:Length of Stay; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: appendicitis; pediatrics; perforated appendicitis