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Deprivation increases perforation risk in paediatric appendicitis


Acute appendicitis is the most common surgical emergency in childhood. Perforation of the appendix conveys a worse outcome.

This case–control study investigated the relationship between deprivation and appendiceal perforation in children in the West of Scotland.

All children undergoing acute appendicectomy over a 2-year period were identified. Basic demographics including Scottish Index of Multiple Deprivation (SIMD) rank and clinical features including time to presentation and surgical findings were recorded. Associations were investigated using multivariable analysis.

304 patients (62% male) underwent appendicectomy. Mean age was 10.4 years (SD ±3.5). Mean time from symptom onset to presentation was 2.3 days (SD ±2.5). Perforation rate was 44.41%.

Perforation was associated with lower age (p=0.004, OR −0.10, 95% CI −0.17 to −0.33), increased time to presentation (p=0.044, OR 0.14, 95% CI 0.004 to 0.27) and SIMD tertile (p=0.027, OR 0.63, 95% CI 0.07 to 1.20). SIMD tertile was not associated with delayed presentation.

Worsening deprivation independently predicts perforation, but this relationship is not mediated through a delay in presentation.

  • paediatric surgery
  • epidemiology

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