Journal List > Korean J Pediatr Gastroenterol Nutr > v.5(2) > 1110428

Korean J Pediatr Gastroenterol Nutr. 2002 Sep;5(2):158-165. Korean.
Published online Sep 30, 2002.
Copyright © 2002 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
Factors for Delayed Diagnosis of Acute Appendicitis in Children
Myung Ki Han, Kyoung Soo Kim, Yu In Park, Jeong Ho Kim, Jung Joo Lee, Bong Seong Kim and Hye Young Kang*
Department of Pediatrics, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea.
*Yonsei Pediatric Clinic, Korea.


We designed this retrospective study to establish the incidence of diagnosic delay in children diagnosed with acute appendicitis and to identify associated factors with delayed diagnosis and its impact on the clinical course.


All cases of children under 15 years of age who underwent appendectomy from 1996 to 2001 at Gangneung Asan Hospital were reviewed. We reviewed signs and symptoms, type of health professional first contacted, the advice given by the health professional and a history of appendicitis in first degree relatives. Diagnostic period is the time elapsed between first complaints and definitive diagnosis. Delay was defined as diagnostic period exceeded the 48 hours. Postoperative course and complications were also reviewed.


Incidence of diagnostic delay differed by whether diarrhea and fecalith on X-ray were present. Also children whose parents were advised to observe them at home were more likely to have a diagnostic delay. In almost half of the cases in delayed group, initial diagnosis was not acute appendicitis but gastroenteritis. The perforation rate in non-delayed group was 22%, whereas 87% in delayed group. The delayed group showed a higher number of postoperative complication and a longer hospitalization period.


Diarrhea with abdominal pain and fever in children should not be dismissed as gastroenteritis, respiratory infections or other common disorders. Our study suggests that physicians have a responsibility to prevent diagnostic delay and resultant perforation of acute appendicitis in children by having a high index of suspicion about acute appendicitis.

Keywords: Diagnostic delay; Acute appendicitis; Perforation