title: A model predicting perforation and complications in paediatric appendicectomy.
abstract: OBJECTIVE
  To analyse the diagnostic value of simple clinical measurements in ensuring an early and accurate detection of advanced appendicitis (perforation, mass and peri-appendicular abscess) and possible complications.
  
  
  METHODS
  A retrospective, single-centre study of all paediatric (age 0-14 years) appendicectomies was conducted over a 14-year period. Preoperative symptoms, signs and laboratory results, intra-operative findings and postoperative complications were analyzed. Receiver operating characteristic (ROC) curves were used to estimate sensitivity and specificity of significant (p ≤ 0.05) predictor variables based on multivariate logistic regression models.
  
  
  RESULTS
  One thousand and thirty-seven patients were included. Perforations were seen in 88 (8.5%) cases, and abscesses were seen in 35 (3.4%) cases. Of all the clinical variables evaluated, preoperative temperature ≥37.5 °C was most discriminatory for advanced appendicitis. Significant other discriminatory clinical variables were WBC count ≥15,100/μL, preoperative anorexia and rebound tenderness. Postoperative complications occurred in 74 (7.1%) patients and were associated with pre-operative temperature ≥37.5 °C and advanced appendicitis.
  
  
  CONCLUSIONS
  Independent clinical predictors of advanced appendicitis exist but lack individual accuracy. In this study, preoperative pyrexia is shown to be highly associated with both advanced appendicitis and development of postoperative complications. This independent factor may point to early need for antibiotic treatment, urgent imaging and subsequent intervention in patients with appendicitis.
authors.affiliation: Department of Surgery, Portiuncula Hospital, Ballinasloe, County Galway, Ireland, obinnaobinwa@rcsi.ie.
authors.forename: Obinna
authors.initials: O
authors.lastname: Obinwa
authors.forename: Colin
authors.initials: C
authors.lastname: Peirce
authors.forename: Michael
authors.initials: M
authors.lastname: Cassidy
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
authors.forename: John
authors.initials: J
authors.lastname: Flynn
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D000855:Anorexia / Q000209:etiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology; D007958:Leukocyte Count; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents