title: Effects of Timing to Diagnosis and Appendectomy in Pediatric Appendicitis.
abstract: OBJECTIVE
  Prospectively follow pediatric appendicitis patients to assess outcomes and rates of appendiceal perforations relative to duration of symptomatology and appendectomy timing.
  
  
  METHODS
  Data were collected on the duration of symptomatology to diagnosis and from diagnosis to appendectomy. Symptomatology duration was evaluated in 24-hour increments, and diagnosis to appendectomy was evaluated in 3-hour intervals. Appendiceal perforation rates, hospital length of stay (LOS), and operating room (OR) times were evaluated.
  
  
  RESULTS
  Data were analyzed on 230 patients. Average age was 9.3 years (±3.2), 93 (40%) were female, and 64 (28%) appendectomies were perforated. Perforations had a mean 10 minutes longer OR time (63 vs 50 minutes, P < 0.001) and a 57% increase in hospital LOS (3 days' interquartile range, 1-5 vs 1 day's interquartile range, 1-3; P < 0.001). From diagnosis to appendectomy, those taken 0 to 3 hours, 4 to 6 hours, or longer than 6 hours after diagnosis had no statistically significant difference in hospital LOS or perforation rates and no clinically significant difference in OR times. Symptomatology greater than 48 hours had hospital LOS 55.7% greater and 4.9 times increased odds for perforation than those 0 to 23 hours (P < 0.05).We found no effect on perforation rates, hospital LOS, or OR time when symptomatology duration was compared independently with timing of surgery.
  
  
  CONCLUSIONS
  Pediatric patients with appendicitis presenting with greater than 48 hours of symptomatology had 4.9 times increased odds of perforation and 56% greater hospital LOS than those presenting within 0 to 23 hours. We were unable to demonstrate a difference in perforation rates based on emergency department LOS before surgery.
authors.affiliation: From the *Department of Emergency Medicine, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM; †Division of Emergency Medicine, Children's Hospital Boston, Boston, MA; and ‡Department of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ.
authors.forename: Katherine
authors.initials: K
authors.lastname: Mandeville
authors.forename: Michael
authors.initials: M
authors.lastname: Monuteaux
authors.forename: Tamara
authors.initials: T
authors.lastname: Pottker
authors.forename: Blake
authors.initials: B
authors.lastname: Bulloch
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D013997:Time Factors