DIAGNOSTIC VALUES OF ANAMNESIS AND PHYSICAL EXAMINATION FINDINGS IN ACUTE ABDOMINAL PAIN AND ACUTE APPENDICITIS IN CHILDREN

Abstract

Objective: The aim of this study was to evaluate the validity of anamnesis and physical examination findings for the diagnosis of acute appendicitis in children with acute abdominal pain and also to. To detect the frequency of the change in diagnosis of acute abdominal pain children who discharged from the emergency department. Material and Method: The causes of abdominal pain were determined in children who were presented with acute abdominal pain. The symptoms were divided in two groups according to their diagnosis as medical and surgical. Frequency of signs and symptoms accompanying to abdominal pain were compared between patients with acute appendicitis and patients with medical diagnosis. The frequency of the change in diagnosis and revisiting the emergency room within ten days upon previous discharge were evaluated. Results: The study included 304 children with a mean age of 9.3 +/- 3.5 years, 254 patients (83.6%) had medical, 50 patients (16.4%) had surgical diagnosis. The most common surgical diagnosis was appendicitis (11.8%). Vomiting, right lower quadrant pain, tenderness, and rebound pain were the most commonly encountered symptoms and findings in acute appendicitis group compared to the medical diagnosis group (p<0.001). While all the patients diagnosed with appendicitis had at least two of these four findings, this ratio was lower in medical group (p<0.001). The frequency of return to emergency unit was 16.3% and change in diagnosis was 5.3%. It was reported that patients with appendicitis who were diagnosed at their second visit were more likely to have diarrhea (n=5, 13.9%). Conclusions: Appendicitis should be considered in patients who present with any two of the following findings: vomiting, right low quadrant pain, tenderness, and rebound pain. It should be kept in mind that appendicitis might be accompanied by another systematic finding like diarrhea.