Predictive Factors for Acute and Complicated Appendicitis in Children: A Prospective Study Çocukluk Yaş Grubunda Akut ve Komplike Apandisit Tanısında Prediktif Faktörlerin Belirlenmesi: Prospektif Bir Çalışma

Bozdağ E. T., ERDEM O., Ateş A., Demir Ş., Tuzcu A., Meteoğlu İ., ...Daha Fazla

Journal of Pediatric Emergency and Intensive Care Medicine (Turkey), cilt.12, sa.3, ss.193-200, 2025 (ESCI, Scopus, TRDizin)

Özet

Introduction: Acute appendicitis is one of the most common surgical emergencies in children, where early diagnosis is crucial to reducing morbidity and mortality. This study aimed to identify predictive factors for appendicitis and evaluate the diagnostic value of serum sodium and blood and urine ketone levels. Methods: This prospective study included patients under 18 years of age who presented with acute abdominal pain and were clinically suspected of having appendicitis. Patients were divided into two groups: appendicitis and non-appendicitis. The appendicitis group was further categorized into acute and complicated cases. Demographic data, clinical symptoms, physical examination findings, symptom duration, preoperative laboratory values, blood and urine ketone levels, and pathology results were recorded. Results: A total of 153 patients were included [100 with appendicitis (51 complicated) and 53 non-appendicitis]. In the appendicitis group, leukocyte count, neutrophil count, C-reactive protein (CRP), blood ketones [area under the curve (AUC)=0.618], and urine ketones (AUC=0.627) were significantly higher (p<0.001, p<0.001, p=0.001, p=0.03, and p=0.04, respectively). Among patients presenting within 24 hours of symptom onset, leukocyte count (p=0.013), neutrophil count (p=0.014), and blood ketones (p=0.035) were significantly higher in the appendicitis group. For patients with symptom duration longer than 24 hours, leukocyte count (p=0.005), neutrophil count (p=0.001), and CRP levels (p=0.001) were significantly elevated, while serum sodium levels were significantly lower (p=0.046) in appendicitis cases. Conclusion: In our study, blood and urine ketone levels were significantly elevated in children with appendicitis. Blood ketones appeared particularly useful in early-stage presentations, whereas CRP elevation and decreased serum sodium were more prominent in delayed cases.