Posted by Andy Jagoda MD in: Brain Tease , trackback
Appendicitis is the most common condition in children requiring emergency abdominal surgery. Delayed or missed diagnosis in young children is common and is associated with increased rates of perforation. Although several scoring systems have been developed, there is still no consensus on clinical, laboratory, and imaging criteria for diagnosing appendicitis.
Our recent issue Acute Appendicitis in Pediatric Patients: An Evidence-Based Review explores key age-based historical and physical examination findings, as well as clinical scoring systems, that can help guide the workup of appendicitis in children.
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Here are a few key points:
- Studies in adults with appendicitis show that abdominal pain almost always precedes vomiting. This typical sequence is less common in preschool-aged children; they can present with vomiting that precedes abdominal pain.
- Fever is the most suggestive sign of appendicitis in patients with undifferentiated abdominal pain. Rovsing sign is the examination finding that is most suggestive of acute appendicitis. Other signs include cough/hop pain and right iliac fossa tenderness.
- Basilar pneumonia should be considered for all children presenting with abdominal pain.