Association of Delay in Appendectomy With Perforation in Children With Appendicitis.

Abstract:

OBJECTIVE:The aim of this study was to assess whether increased time from emergency department (ED) triage to appendectomy is associated with a greater risk of children developing appendiceal perforation. METHODS:We performed a multicenter retrospective cohort study of children younger than 18 years hospitalized with appendicitis. To avoid enrolling patients who had perforated prior to ED arrival, we included only children who had a computed tomography (CT) scan demonstrating nonperforated appendicitis. Time to appendectomy was measured as time from ED triage to incision. The main outcome was appendiceal perforation as documented in the surgical report. Variables associated with perforation in bivariate analysis (P < 0.05) were adjusted for using logistic regression. RESULTS:Overall, 857 patients had a CT scan that demonstrated nonperforated appendicitis. The median age was 12 years (interquartile range, 9-15 years), and 500 (58%) were male. The median time to appendectomy was 11 hours (interquartile range, 8-15 hours). In total, 111 patients (13%) had perforated appendicitis at operation. Children who developed perforation were more likely to require additional CT scans and return to the ED and had a significantly longer length of stay. After adjusting for potential confounders, every hour increase in the time from ED triage to incision was independently associated with a 2% increase in the odds of perforation (P = 0.03; adjusted odds ratio, 1.02; 95% confidence interval, 1.00-1.04). CONCLUSIONS:Delays in appendectomy were associated with an increase in the odds of perforation. These results suggest that prolonged delays to appendectomy might be harmful for children with appendicitis and should be minimized to prevent associated morbidity.

journal_name

Pediatr Emerg Care

journal_title

Pediatric emergency care

authors

Meltzer JA,Kunkov S,Chao JH,Tay ET,George JP,Borukhov D,Alerhand S,Harrison PA,Hom J,Crain EF

doi

10.1097/PEC.0000000000000850

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

45-49

issue

1

eissn

0749-5161

issn

1535-1815

journal_volume

35

pub_type

杂志文章,多中心研究
  • Current variability of clinical practice management of pediatric diabetic ketoacidosis in Illinois pediatric emergency departments.

    abstract:OBJECTIVE:This study aimed to investigate the management of pediatric patients with diabetic ketoacidosis (DKA) presenting to emergency departments (EDs) participating in the Illinois Emergency Medical Services for Children (EMSC) Facility Recognition program. METHODS:In 2010, Illinois EMSC conducted a survey (includi...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3182768bfc

    authors: Barrios EK,Hageman J,Lyons E,Janies K,Leonard D,Duck S,Fuchs S

    更新日期:2012-12-01 00:00:00

  • Pediatric Major Vascular Injuries: A 16-Year Institutional Experience From a Combined Adult and Pediatric Trauma Center.

    abstract:OBJECTIVES:Vascular injury in pediatric trauma patients is uncommon but associated with a reported mortality greater than 19% in some series. The purpose of this study was to characterize pediatric major vascular injuries (MVIs) and analyze mortality at a high-volume combined adult and pediatric trauma center. METHODS...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001642

    authors: Perea LL,Hazelton JP,Fox N,Gaughan JP,Porter J,Goldenberg A

    更新日期:2018-10-17 00:00:00

  • Tracheal Rupture: A Rare Complication of Endotracheal Intubation.

    abstract::There are numerous immediate and delayed complications associated with endotracheal intubation. Tracheal rupture is a rare complication whose diagnosis is often delayed. This can result in significant morbidity and mortality. We present a case of therapeutic misadventure resulting in a significant tracheal rupture in ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000279

    authors: Reichman EF,Lanan BJ

    更新日期:2015-11-01 00:00:00

  • Child Mental Health Services in the Emergency Department: Disparities in Access.

    abstract:OBJECTIVE:Recent research suggests that increasing numbers of caregivers are bringing their children to the emergency department (ED) for mental health services and that a large proportion of these children have Medicaid as their insurance. The objective of this study was to examine the characteristics of children with...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000336

    authors: Lynch S,Bautista M,Freer C,Kalynych C,Hendry P

    更新日期:2015-07-01 00:00:00

  • Evaluating the Implementation Barriers of an Intranasal Fentanyl Pain Pathway for Pediatric Long-Bone Fractures.

    abstract:OBJECTIVES:This study aimed to assess physician comfort, knowledge, and implementation barriers regarding the use of intranasal fentanyl (INF) for pain management in patients with long-bone fractures in a pediatric emergency department (ED) with an INF pain pathway. METHODS:A retrospective chart review was conducted o...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001375

    authors: Arnautovic T,Sommese K,Mullan PC,Frazier SB,Vazifedan T,Ramirez DE

    更新日期:2018-07-01 00:00:00

  • Recurrent pleural effusions in a neonate.

    abstract::Difficulty breathing is a common presenting complaint for infants in the emergency department (ED). Periodic breathing, respiratory or systemic infection, and congenital heart disease are common diagnoses in this age group. We report the case of a male neonate presenting to the ED on multiple occasions with respirator...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e31815f6f34

    authors: Lim RK,Malik SA

    更新日期:2008-01-01 00:00:00

  • Hypokalemia in an asthmatic child from abuse of albuterol metered dose inhaler.

    abstract::A case of albuterol abuse by a pediatric patient with the development of hypokalemia with electrocardiographic changes is presented. The hypokalemic effects of beta2-agonists are discussed in regard to the production of significant cardiac symptoms. Additionally, guidance regarding the evaluation of similar patients p...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199804000-00015

    authors: Rakhmanina NY,Kearns GL,Farrar HC 3rd

    更新日期:1998-04-01 00:00:00

  • Utilization of a pediatric observation unit for toxicologic ingestions.

    abstract:OBJECTIVES:The objectives of this study were to evaluate the efficacy and utilization of an observation unit (OU) for admission of pediatric patients after a toxicologic ingestion; compare the characteristics and outcomes of patients admitted to the pediatric OU, inpatient (IP) service, and intensive care unit (ICU) af...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3182717329

    authors: Plumb J,Dudley NC,Herman BE,Kadish HA

    更新日期:2012-11-01 00:00:00

  • Sudden death in an infant revealing atypical Kawasaki disease.

    abstract::We present a case of a 4-month-old girl referred to the emergency department with a provisional diagnosis of acute life-threatening event with a recent episode of heart block and a history of long-lasting fever. Soon after admission, the child suddenly deteriorated rapidly; she became pulseless with complete heart blo...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000195757.74328.68

    authors: Diana MC,Villa G,Gattorno M,Ottonello G,Costabel S,Savioli C,DiPietro P

    更新日期:2006-01-01 00:00:00

  • Emergency department management of blunt cervical tracheal trauma in children.

    abstract::A case history of a young girl who sustained a small posterior laceration of her cervical trachea after blunt trauma is presented. She was brought to the emergency department (ED) by her parents roughly two hours after the incident with only minor symptoms. While in the ED, she developed significant airway compromise ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199110000-00008

    authors: Humar A,Pitters C

    更新日期:1991-10-01 00:00:00

  • Intussusception: a supplement to the mnemonic for coma.

    abstract::Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pa...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198706000-00015

    authors: McCabe JB,Singer JI,Love T,Roth R

    更新日期:1987-06-01 00:00:00

  • Missed opportunities during pediatric residency training: report of a 10-year follow-up survey in critical care transport medicine.

    abstract:OBJECTIVES:The Accreditation Council for Graduate Medical Education requires pediatric residency training programs to provide exposure to the prehospital management and transport of patients. The authors hypothesized that compared with a similar study a decade prior, current pediatric residency training programs have r...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e31823ed4ab

    authors: Kline-Krammes S,Wheeler DS,Schwartz HP,Forbes M,Bigham MT

    更新日期:2012-01-01 00:00:00

  • Holiday ornament-related injuries in children.

    abstract:OBJECTIVES:Holiday ornament injuries in children have not been well documented in the medical literature. Our aim was to investigate the patterns of injuries sustained from these ornaments as a first measure toward prevention. METHODS:This was a retrospective cohort analysis of all patients examined in an urban pediat...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3181c33109

    authors: Kimia A,Lee L,Shannon M,Capraro A,Mays D,Johnston P,Hummel D,Shuman M

    更新日期:2009-12-01 00:00:00

  • Ability of hospitals to care for pediatric emergency patients.

    abstract:CONTEXT:The needs of children in emergency situations differ from those of adults and require special attention, yet there has been no study of the ability of U.S. hospitals to care for emergently or critically ill children. OBJECTIVE:To estimate the distribution of pediatric services available at U.S. hospitals with ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-200106000-00005

    authors: Athey J,Dean JM,Ball J,Wiebe R,Melese-d'Hospital I

    更新日期:2001-06-01 00:00:00

  • Concentrated liquid detergent pod ingestion in children.

    abstract::Concentrated liquid detergent pods are an emerging public health hazard, especially in pediatric patients. Ingestion is a more common route of exposure for liquid detergent pods compared with non-pod detergents and it tends to be associated with more severe adverse effects. We present 3 cases that demonstrate the vari...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000292

    authors: Sidhu N,Jaeger MW

    更新日期:2014-12-01 00:00:00

  • Hair tourniquet management.

    abstract::Unwind or incise has been the standard of management for removing hair tourniquets. The hair ends are usually difficult to hold and unwind as they break at the ends easily, and using scalpels or needles to get under the hair tourniquet is difficult when the involved appendage is swollen and leads to more trauma to the...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e31820d65b7

    authors: O'Gorman A,Ratnapalan S

    更新日期:2011-03-01 00:00:00

  • Spontaneous pneumorrhachis.

    abstract::Pneumomediastinum is a relatively uncommon occurrence in pediatric patients. After mediastinal air leak, air may dissect through a variety of tissue planes within the chest, neck, and abdomen. We report the case of a 16-year-old adolescent boy who presented with spontaneous pneumomediastinum accompanied by the presenc...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e31828a38ad

    authors: Carolan PL,Wright SL,Jha V

    更新日期:2013-04-01 00:00:00

  • An unusual complication from a femoral venous catheter.

    abstract::We report a case of a child with sickle cell disease and decreased intravascular volume secondary to splenic sequestration in whom a femoral venous catheter dislodged, infiltrated into the soft tissue of the anterior abdominal wall, and caused clinical signs of peritonitis. Inability to recognize this complication led...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198803000-00009

    authors: Bonadio WA,Losek JD,Melzer-Lange M

    更新日期:1988-03-01 00:00:00

  • Charges and complications associated with the medical evaluation of febrile young infants.

    abstract:BACKGROUND:Since 1983, no study has evaluated the costs and complications involved in the inpatient evaluation of antibiotic therapy for febrile infants aged 29 to 60 days. METHODS:A prospective quality indicator/quality assurance study of low-risk febrile young infants (FYIs) was conducted during a 16-month period af...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3181d1e180

    authors: Condra CS,Parbhu B,Lorenz D,Herr SM

    更新日期:2010-03-01 00:00:00

  • Fell on outstretched hand.

    abstract::Radial neck fractures in children are not uncommon. Most are minimally displaced or nondisplaced. Severely displaced fractures or angulated radial neck fractures in children often have poor outcomes, especially if not reduced, and even after open reduction. ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000235839.44449.36

    authors: Waseem M,Devas G,Perales O

    更新日期:2006-09-01 00:00:00

  • Neonatal seizures: soothing a burning topic.

    abstract::Neonatal seizures are a potentially life-threatening pediatric problem with a variety of causes, such as birth trauma, asphyxia, congenital anomalies, metabolic disturbances, infections, and drug withdrawal or intoxication. Thorough and timely evaluations of such patients are necessary to identify and treat the underl...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3182a62fd6

    authors: Thornton MD,Chen L,Langhan ML

    更新日期:2013-10-01 00:00:00

  • Acute Dystonia Versus Neuroleptic Malignant Syndrome Without Fever in an Eight-Year-Old Child.

    abstract::Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication of the use of certain medications. It is being seen more often in the pediatric population because of the increasing use of both typical and atypical antipsychotics in children. Rapid recognition of NMS is important to emergency physicia...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001000

    authors: Sridaran R,Nesbit CE

    更新日期:2017-01-01 00:00:00

  • Redefining the community pediatric hospitalist: the combined pediatric ED/inpatient unit.

    abstract:BACKGROUND:The use of pediatric hospitalists in community hospitals has increased over the past decade in response to the desire to provide high-quality pediatric care. Many hospitals are challenged to create financially independent and productive programs. OBJECTIVE:To evaluate an alternative approach to traditional ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000248685.94647.01

    authors: Krugman SD,Suggs A,Photowala HY,Beck A

    更新日期:2007-01-01 00:00:00

  • Update on antidotes for pediatric poisoning.

    abstract::Antidotes are playing an increasing role in therapy for pediatric poisonings. Although initial response to all pediatric poisonings begins with basic stabilization, knowledge of specific antidotes, their mechanisms of action, safety profile in pediatrics, and dosing regimens can be life-saving for pediatric victims of...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:10.1097/01.pec.0000245174.21041.bc

    authors: White ML,Liebelt EL

    更新日期:2006-11-01 00:00:00

  • The Effects of Pediatric Advanced Life Support Guidelines on Pediatric Trauma Airway Management.

    abstract:OBJECTIVE:Recent Pediatric Advanced Life Support (PALS) guidelines have deemphasized the use of advanced airways in short transport. It is unclear if guideline recommendations have altered practice. We sought to determine if a temporal change exists in the number of prehospital pediatric trauma intubations since the 20...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000759

    authors: Sperka J,Hanson SJ,Hoffmann RG,Dasgupta M,Meyer MT

    更新日期:2016-08-01 00:00:00

  • Pediatric prehospital evaluation of NYC respiratory arrest survival (PHENYCS).

    abstract:OBJECTIVE:The objective of this study was to describe the demographics, epidemiology, and characteristics associated with survival of children younger than 18 years who had an out-of-hospital respiratory arrest (OOHRA) during a 1-year period in a large urban area. METHODS:A prospective observational cohort of consecut...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3182675b61

    authors: Tunik MG,Richmond N,Treiber M,Skomorowsky A,Galea S,Vlahov D,Blaney S,Kusick M,Silverman R,Foltin GL

    更新日期:2012-09-01 00:00:00

  • The cause of gait disturbance in 425 pediatric patients.

    abstract::Children who seek attention for painful or painless alteration of gait provide a challenge to the emergency department physician who confronts such cases. Children with acute onset of limp or refusal to walk may become the center of diagnostic and therapeutic concern in approximately 4 percent of pediatric patient enc...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198503000-00003

    authors: Singer JI

    更新日期:1985-03-01 00:00:00

  • Central venous access via external jugular vein in children.

    abstract:OBJECTIVE:To determine the success rate and complications of using the external jugular (EJ) vein for central venous access in pediatric patients. METHODS:Prospective cohort study of children who underwent attempts at EJ vein central venous access while receiving care in an 11-bed pediatric intensive care unit at an u...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3181ea71ca

    authors: Tecklenburg FW,Cochran JB,Webb SA,Habib DM,Losek JD

    更新日期:2010-08-01 00:00:00

  • Evaluation of Predictors of Mortality Associated With Childhood Heart Failure in Nigeria: A 2-Center Study.

    abstract:OBJECTIVE:The aim of this study was to evaluate the predictors of mortality in childhood heart failure (HF) in 2 tertiary hospitals. METHODS:A 51-month retrospective review of case notes of children with HF admitted into children's emergency rooms of 2 tertiary centers in Southern Nigeria was done. Bio-data and certai...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/PEC.0000000000001427

    authors: Sadoh WE,Okperi B,Ikhurionan P,Monday P,Sadoh AE

    更新日期:2020-05-01 00:00:00

  • The edematous toddler: a case of pediatric Ménétrier disease.

    abstract::Ménétrier disease is a protein-losing gastroenteropathy, characterized clinically by nonspecific gastrointestinal symptoms and generalized edema, biochemically by hypoalbuminemia, and pathologically by enlarged gastric folds. Distinct from its adult counterpart, Ménétrier disease of childhood usually remits spontaneou...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:10.1097/PEC.0b013e3181887e89

    authors: Blackstone MM,Mittal MK

    更新日期:2008-10-01 00:00:00