Smartest Doc
Antibiotic Administration Can Be an Independent Risk Factor for Therapeutic Delay of Pediatric Acute Appendicitis
Pediatric Emergency Care, 08/10/2012
Clinical Article
Nomura O et al. – Prior treatment with antibiotics was an independent risk factor for therapeutic delay in pediatric acute appendicitis (AA).
Methods- The authors conducted a retrospective chart review of AA children operated on between 2003 and 2008 at tertiary-care pediatric and perinatal hospitals.
- Univariate and multivariate logistic regressions were analyzed to determine independent risk factors of therapeutic delay in pediatric AA.
- The duration between the onset of symptoms and surgery was more than 48 hours (therapeutic delay) in 50 patients (25%, group A) and 48 hours or less in 151 patients (75%, group B).
- The patients in group A had a significantly higher frequency of diarrhea (48% vs 12%; P < 0.0001).
- The percentages of children who had previously received antibiotics were more frequent in group A (46% vs 8%; P < 0.0001).
- The median C-reactive protein levels (72 vs 7 mg/L; P < 0.0001) and frequency of perforation (60% vs 13%; P < 0.0001) were statistically significantly higher in group A.
- A multivariate analysis demonstrated that the independent risk factors of therapeutic delay were history of receiving antibiotics (odds ratio [OR], 5.8; 95% confidence interval [CI], 2.3–15.5), diarrhea (OR, 5.2; 95% CI, 2.1–13.1), and elevated C-reactive protein levels (OR, 4.5; 95% CI, 1.9–10.8).