title: Risk factors of delayed diagnosis of acute appendicitis in children: for early detection of acute appendicitis.
abstract: OBJECTIVE
  This study examined the risk factors of a delayed diagnosis of acute appendicitis in children undergoing an appendectomy.
  
  
  METHODS
  This retrospective study involved children aged below 18 years, who underwent an appendectomy. After dividing them into a delayed diagnosis group and nondelayed diagnosis group according to the time interval between the initial hospital visit and final diagnosis, the risk factors of delayed diagnosis were identified using logistic regression analysis.
  
  
  RESULTS
  Among 712 patients, 105 patients (14.7%) were classified in the delayed diagnosis group; 92 patients (12.9%) were diagnosed using ultrasonography (US), and both US and computed tomography were performed in 38 patients (5.3%). More patients in the delayed diagnosis group underwent US (P=0.03). Spring season and prior local clinic visit were significantly associated with a delayed diagnosis. Fever and diarrhea were more common in the delayed diagnosis group (fever: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.05-1.81; diarrhea: OR, 1.94; 95% CI, 1.08-3.46; P<0.05). These patients showed symptoms for a longer duration (OR, 2.59; 95% CI, 1.78-3.78; P<0.05), and the admission course (OR, 1.26; 95% CI, 1.11-1.44; P<0.05) and C-reactive protein (CRP) levels (OR, 1.47; 95% CI, 1.19-1.82; P<0.05) were associated with the delayed diagnosis.
  
  
  CONCLUSIONS
  To decrease the rate of delayed diagnoses of acute appendicitis, symptoms such as fever and diarrhea, seasonal variations, admission course, and CRP levels should be considered and children with a longer duration of symptoms should be closely monitored.
authors.affiliation: Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jea Yeon
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Eell
authors.initials: E
authors.lastname: Ryoo
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Jo
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Tchah
authors.initials: T
authors.lastname: Hann
authors.affiliation: Department of General Surgery, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Seong Min
authors.initials: SM
authors.lastname: Kim
keywords: Appendicitis; Child; Delayed diagnosis; Risk factors