Does this child have appendicitis? Watch out for key signs

August 2, 2007

A 5-year-old with abdominal pain, nausea and fever may have appendicitis or any of a number of other problems. But how does the child’s doctor decide whether to schedule an emergency appendectomy to surgically remove a presumably inflamed appendix — a procedure that carries its own risks like any surgery — or wait and observe what could be a ticking time bomb that could rupture and kill the patient in a matter of hours?

It’s a classic physician’s dilemma, but a new study led by the Johns Hopkins Children’s Center may ease the pediatrician’s problem-solving and parents’ anxiety.

Reporting on their review of the frequency of the most common symptoms of actual appendicitis in children, the researchers concluded that beyond fever, the most telltale signs are “rebound” tenderness or pain that occurs after pressure is removed abruptly from the lower right part of the abdomen; abdominal pain that starts around the belly button and migrates down and to the right; and an elevated white blood cell count (10,000 or more per microliter), which is a marker of infection in the body.

Notably, loss of appetite, nausea and vomiting, hallmark appendicitis symptoms in adults, were NOT predictive of appendicitis in children.

“These signs don’t give you an absolute diagnosis, but they should prompt the doctor to refer the child to a surgeon for evaluation,” said study lead author David Bundy, M.D., M.P.H., a pediatrician at the Johns Hopkins Children’s Center.

Appendicitis is most common in teens and young adults in their early 20s. However, children younger than 4 years are at the highest risk for a rupture. Up to 80 percent of appendicitis cases in this age group end in rupture, partly because young children have fewer of the classic symptoms of nausea, vomiting and pain localized in the lower right portion of the abdomen than do teenagers and young adults, making the diagnosis easy to miss or delay. In the study report, published in the July 25 issue of the Journal of the American Medical Association, the researchers said ultrasound and CT scan images can be helpful, but are not always conclusive, even if they are available on an emergency basis. And CT scans in particular expose young children to radiation, which should be avoided if possible.

“In a very young child, the presentation of symptoms associated with appendicitis tends to be different from adults, so when trying to decide between fast-track surgery versus watchful observation, you’re often damned if you do and damned if you don’t,” Bundy said. “In our analysis, we’ve identified some of the more powerful telltale signs that should help residents, general pediatricians and ER doctors narrow down what is seldom a clear-cut diagnosis.”

The appendix is a small tube extending from the large intestine, and infections and inflammation of the organ can be dangerous. The only absolute way to diagnose the condition is surgery, and each year, appendicitis sends 77,000 American children to the hospital. An estimated one-third of them suffer a ruptured appendix, a life-threatening complication, before they reach the OR.

In their analysis of previous research, investigators searched hundreds of studies, weeding out weak from solid science. The 25 studies that made the final cut examined symptoms and outcomes in children who presented with abdominal pain and in whom appendicitis was considered a possible diagnosis. Abdominal pain in children is one of the most common and vaguest symptoms, and can suggest anything from innocent constipation to serious infections or blockages of the intestines. Doctors advise parents that any abdominal pain should be evaluated for appendicitis. “We really want parents to keep in mind that children with appendicitis don’t always show up with the classic story that we see in adults,” Bundy says. “There isn’t a perfect formula, but we think the signs we’ve identified can help.”

Source: Johns Hopkins Medical Institutions

Explore further: Kids' well visits linked to lower appendicitis complications

Related Stories

Kids' well visits linked to lower appendicitis complications

January 31, 2018
Children in the United States whose families visited a doctor in the previous year were less likely to experience a common complication of appendicitis, an analysis of insurance claims shows.

Racial disparities in pain treatment of children with appendicitis in EDs

September 14, 2015
Black children were less likely to receive any pain medication for moderate pain and less likely to receive opioids for severe pain than white children in a study of racial disparities in the pain management of children with ...

New study on acupuncture to reduce pain and inflammation in children with acute appendicitis

May 13, 2015
Acupuncture was shown to lessen pain and reduce the underlying inflammation in pediatric patients with a diagnosis of acute appendicitis, according to a study published in the Journal of Alternative and Complementary Medicine.

Study reports racial disparities in pediatric appendicitis treatment tied to hospital type

December 28, 2012
When researchers from UCLA Medical Center investigated the link between racial disparities and appendicitis outcomes in children, they found that the type of hospital in which black, Hispanic and other minority patients receive ...

Lab tests and ultrasounds identify children who need surgical treatment for appendicitis

February 19, 2015
Data from two standard diagnostic tests commonly obtained in children evaluated for abdominal pain—when combined—can improve the ability of emergency department physicians and pediatric surgeons to identify those patients ...

Antibiotics alone can be a safe, effective treatment for children with appendicitis

December 16, 2015
Using antibiotics alone to treat children with uncomplicated acute appendicitis is a reasonable alternative to surgery when chosen by the family. A study led by researchers at Nationwide Children's Hospital found that three ...

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.