{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:21:34Z","timestamp":1783657294018,"version":"3.55.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>In children with appendicitis, rupture of the appendix is associated with a significant increase in morbidity. We sought to characterize the spectrum of illness in children with complicated appendicitis and to define those factors associated with a longer hospital stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We conducted a retrospective review of 132 children, 18 years of age or younger at a large urban teaching hospital in the Bronx, NY between October 2015 and April 2018 with an intraoperative diagnosis of perforated appendix. Clinical, laboratory and radiologic findings were reviewed, and the primary study outcome was length of stay (LOS) dichotomized at the median, which was 7 days. Statistical analyses were done to characterize morbidity and define variables predictive of longer stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Children in the longer LOS group experienced significantly more morbidity, including ICU stay, ileus, and need for multiple drainage procedures. A longer duration of symptoms prior to presentation was associated with a longer stay. Multivariable logistic regression analysis indicated that the presence of abscess and presence of free fluid in the right upper quadrant (RUQ FF) on initial imaging and C-reactive protein (CRP) level &amp;gt;12 at admission, were independently associated with a longer stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is considerable variation in the morbidity of complicated appendicitis. The association between longer stay and the findings of abscess and RUQ FF on initial imaging along with an elevated CRP may provide a useful tool in identifying those children at risk for worse outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2022.828748","type":"journal-article","created":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T04:47:01Z","timestamp":1649220421000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis"],"prefix":"10.3389","volume":"10","author":[{"given":"Jyotsna","family":"Bhattacharya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen J.","family":"Silver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Einat","family":"Blumfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique M.","family":"Jan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betsy C.","family":"Herold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Goldman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,4,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.1016\/j.jpedsurg.2017.02.009","article-title":"Regional variation in rates of pediatric perforated appendicitis.","volume":"52","author":"Sarda","year":"2017","journal-title":"J Pediatr Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1478-7954-3-4","article-title":"Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access.","volume":"3","author":"Jablonski","year":"2005","journal-title":"Popul Health Metr."},{"key":"B3","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1001\/jamapediatrics.2017.0885","article-title":"Time to appendectomy and risk of complicated appendicitis and adverse outcomes in children.","volume":"171","author":"Serres","year":"2017","journal-title":"JAMA Pediatr."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e160194","DOI":"10.1001\/jamasurg.2016.0194","article-title":"Effect of a clinical practice guideline for pediatric complicated appendicitis.","volume":"151","author":"Willis","year":"2016","journal-title":"JAMA Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1007\/s11684-013-0259-1","article-title":"Appendiceal inflammation affects the length of stay following appendicectomy amongst children: a myth or reality?","volume":"7","author":"Siddique","year":"2013","journal-title":"Front Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1055\/s-0040-1712508","article-title":"A nationwide cohort study of outcome after pediatric appendicitis.","volume":"31","author":"Omling","year":"2021","journal-title":"Eur J Pediatr Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1007\/s10140-017-1535-1","article-title":"Scoring system for differentiating perforated and non-perforated pediatric appendicitis.","volume":"24","author":"Blumfield","year":"2017","journal-title":"Emerg Radiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1007\/s00247-017-3900-3","article-title":"Differentiating perforated from non-perforated appendicitis on contrast-enhanced magnetic resonance imaging.","volume":"47","author":"Rosenbaum","year":"2017","journal-title":"Pediatr Radiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1016\/j.surg.2009.11.013","article-title":"A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon).","volume":"147","author":"Simillis","year":"2010","journal-title":"Surgery."},{"key":"B10","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1001\/archsurg.2011.6","article-title":"Early vs interval appendectomy for children with perforated appendicitis.","volume":"146","author":"Blakely","year":"2011","journal-title":"Arch Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e2156","DOI":"10.1136\/bmj.e2156","article-title":"Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials.","volume":"344","author":"Varadhan","year":"2012","journal-title":"BMJ."},{"key":"B12","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1056\/NEJM200107123450205","article-title":"Neighborhood of residence and incidence of coronary heart disease.","volume":"345","author":"Diez Roux","year":"2001","journal-title":"N Engl J Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1542\/peds.109.1.45","article-title":"Centers for disease control and prevention 2000 growth charts for the United States: improvements to the 1977 national center for health statistics version.","volume":"109","author":"Ogden","year":"2002","journal-title":"Pediatrics."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1016\/j.jpedsurg.2020.09.066","article-title":"Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: a prospective study.","volume":"56","author":"Pogorelic","year":"2020","journal-title":"J Pediatr Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1097\/01.PCC.0000149131.72248.E6","article-title":"International consensus conference on pediatric S. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics.","volume":"6","author":"Goldstein","year":"2005","journal-title":"Pediatr Crit Care Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/1471-2482-6-15","article-title":"Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children.","volume":"6","author":"Sack","year":"2006","journal-title":"BMC Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"230","DOI":"10.14423\/SMJ.0000000000000438","article-title":"Predictors of a prolonged length of stay in children with perforated appendicitis.","volume":"109","author":"Pathak","year":"2016","journal-title":"South Med J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1111\/j.1553-2712.2003.tb00606.x","article-title":"Racial and ethnic disparities in pediatric appendicitis rupture rate.","volume":"10","author":"Guagliardo","year":"2003","journal-title":"Acad Emerg Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1542\/peds.2004-1363","article-title":"Effects of race, insurance status, and hospital volume on perforated appendicitis in children.","volume":"115","author":"Smink","year":"2005","journal-title":"Pediatrics."},{"key":"B20","first-page":"20","article-title":"Influence of overweight and obesity on acute appendicitis in children. A cohort study (Influencia del sobrepeso y obesidad infantil en la apendicitis aguda en ninos. Estudio de cohortes).","volume":"33","author":"Delgado-Miguel","year":"2020","journal-title":"Cir Pediatr."},{"key":"B21","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1353\/hpu.2012.0017","article-title":"The association of body mass index and perforation of the appendix in Puerto Rican children.","volume":"23","author":"Ramos","year":"2012","journal-title":"J Health Care Poor Underserved."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1016\/j.jpedsurg.2016.02.085","article-title":"Effect of body mass index percentile on pediatric gastrointestinal surgery outcomes.","volume":"51","author":"Witt","year":"2016","journal-title":"J Pediatr Surg."},{"key":"B23","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1258\/shorts.2011.011025","article-title":"Diagnostic accuracy of white cell count and C-reactive protein for assessing the severity of paediatric appendicitis.","volume":"2","author":"Siddique","year":"2011","journal-title":"JRSM Short Rep."},{"key":"B24","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1046\/j.1365-2168.1999.01063.x","article-title":"Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis.","volume":"86","author":"Gronroos","year":"1999","journal-title":"Br J Surg."},{"key":"B25","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1542\/peds.76.2.301","article-title":"Childhood appendicitis: factors associated with perforation.","volume":"76","author":"Brender","year":"1985","journal-title":"Pediatrics."},{"key":"B26","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jamcollsurg.2005.11.016","article-title":"How time affects the risk of rupture in appendicitis.","volume":"202","author":"Bickell","year":"2006","journal-title":"J Am Coll Surg."},{"key":"B27","first-page":"101","article-title":"Perforation rate relates to delayed presentation in childhood acute appendicitis.","volume":"43","author":"Williams","year":"1998","journal-title":"J R Coll Surg Edinb."},{"key":"B28","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1089\/sur.2017.210","article-title":"Microbiologic analysis of complicated and uncomplicated acute appendicitis.","volume":"19","author":"Garcia-Marin","year":"2018","journal-title":"Surg Infect (Larchmt)."},{"key":"B29","doi-asserted-by":"publisher","first-page":"9032","DOI":"10.1038\/s41598-020-65977-z","article-title":"Clinical characteristics of infections caused by Streptococcus anginosus group.","volume":"10","author":"Jiang","year":"2020","journal-title":"Sci Rep."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e0172223","DOI":"10.1371\/journal.pone.0172223","article-title":"Streptococcus sanguinis induces neutrophil cell death by production of hydrogen peroxide.","volume":"12","author":"Sumioka","year":"2017","journal-title":"PLoS One."},{"key":"B31","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1128\/JCM.01807-09","article-title":"Characterization of Streptococcus milleri group isolates from expectorated sputum of adult patients with cystic fibrosis.","volume":"48","author":"Grinwis","year":"2010","journal-title":"J Clin Microbiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.jpedsurg.2017.11.009","article-title":"Streptococcus anginosus is associated with postoperative intraabdominal collections in appendicitis.","volume":"53","author":"Subramanian","year":"2018","journal-title":"J Pediatr Surg."},{"key":"B33","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.jpedsurg.2011.08.004","article-title":"Streptococcus milleri in intraabdominal abscesses in children after appendectomy: incidence and course.","volume":"47","author":"Leeuwenburgh","year":"2012","journal-title":"J Pediatr Surg."},{"key":"B34","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1086\/649554","article-title":"Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the surgical infection society and the infectious diseases society of America.","volume":"50","author":"Solomkin","year":"2010","journal-title":"Clin Infect Dis."},{"key":"B35","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s00383-018-04428-3","article-title":"Intraoperative cultures during appendectomy in children are poor predictors of pathogens and resistance patterns in cultures from postoperative abscesses.","volume":"35","author":"Dahlberg","year":"2019","journal-title":"Pediatr Surg Int."},{"key":"B36","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.ijsu.2015.12.063","article-title":"Antibiotic resistance evaluation and clinical analysis of acute appendicitis; report of 1431 consecutive worldwide patients: a cohort study.","volume":"26","author":"Coccolini","year":"2016","journal-title":"Int J Surg."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1016\/j.jpedsurg.2021.03.027","article-title":"Updates on bacterial resistance and empirical antibiotics treatment of complicated acute appendicitis in children.","volume":"56","author":"Kwok","year":"2021","journal-title":"J Pediatr Surg."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1007\/s00431-021-03994-4","article-title":"The intraperitoneal bacteriology and antimicrobial resistance in acute appendicitis among children: a retrospective cohort study between the years 2007-2017.","volume":"180","author":"Dabaja-Younis","year":"2021","journal-title":"Eur J Pediatr."},{"key":"B39","doi-asserted-by":"publisher","first-page":"e290","DOI":"10.1097\/INF.0000000000002420","article-title":"Contemporary microbiology and antimicrobial treatment of complicated appendicitis: the value of a short-term study.","volume":"38","author":"Viel-Theriault","year":"2019","journal-title":"Pediatr Infect Dis J."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.828748\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T04:47:05Z","timestamp":1649220425000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.828748\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,6]]},"references-count":39,"alternative-id":["10.3389\/fped.2022.828748"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.828748","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,6]]},"article-number":"828748"}}