Brender et al identified risk factors for perforation in a child with acute appendicitis. These can help identify a child with abdominal pain who may benefit from early and aggressive management. The authors are from the University of Washington in Seattle.


Patient selection: pediatric patient with abdominal pain


Risk factors for perforation:

(1) young age (<= 8 years, with appendicitis often not considered)

(2) delay in treatment > 36 hours

(3) no family history of appendicitis (a family history indicates greater awareness)


Additional factors:

(1) presence of fecalith

(2) told by the first health care professional contacted to observe the child at home

(3) low social class (in multivariate analysis less significant when other factors present)


One factor not mentioned that can lead to a delay in diagnosis is presentation during an outbreak of viral gastroenteritis, when there are many children with abdominal pain.


A key message is that any child with abdominal pain should be examined at the physician's office, clinic or hospital.


To read more or access our algorithms and calculators, please log in or register.