Prognostic factors predisposing to conservative treatment failure in children (aged 7 to 18) with uncomplicated acute appendicitis

Although appendectomy is the “gold standard” in the treatment of acute appendicitis, a conservative approach is gaining popularity. The aim of this study is to evaluate symptoms, objective signs, laboratory and ultrasound (US) findings that can lead to failure of antibacterial therapy in children with uncomplicated acute appendicitis (UCAP at Children’s Clinical University Hospital (CCUH). A retrospective study was made to evaluate objective signs and symptoms, laboratory and US findings in medical records among patients aged 7 to 18 years old admitted to CCUH from January 2018 to December 2018 with diagnosis of uncomplicated acute appendicitis. The patients were divided into two groups according to outcome of conservative therapy – A and B. In group A were 103 (72.02%) patients whose condition improved during antibacterial therapy and they were discharged on oral antibiotics. In group B were 40 (27.98%) patients whose condition did not improve after 48 hours of initiation of therapy and they underwent appendectomy. Data were analyzed by IBM SPSS Statistics 22 program (Fisher’s Exact test, Pearson Chi-Square test, Mann-Whitney U test, Shapiro-Wilk test). A total of 143 patient were included (78 boys (54.5%) and 65 girls (45.5%)). Median age was 12.0 (IQR 10.0-14.0 years). Fisher’s Exact test gave statistically significant association between ALVARADO score severity groups and treatment groups (p=0.001). Pearson Chi-Square test gave statistically significant association between nausea, vomiting, leucocytosis and shift to the left in treatment groups (χ2=8.14, p=0.017 and χ2 =12.22, p=0.002 and χ2=18.68, p<0.001 and χ2=7.82, p=0.02).  There was no statistically significant difference in distribution of diameter across categories in groups (Mann-Whitney U test, U=844.0, p=0.206). Presence of nausea, vomiting, leucocytosis and shift to the left suggests probability of increased risk of conservative treatment failure. Therefore, clinical signs and laboratory findings may indicate lack of efficacy in conservative therapy in children diagnosed with uncomplicated acute appendicitis.