Unusual clinical presentation of acute appendicitis in preschool children leads to misdiagnosis and complications. We aimed to analyze the influence of age on clinical presentation, laboratory findings and complications in preschool children with acute appendicitis. From January 2012 until December 2017, 29 children younger than 6 years of age (median 50 months) with acute appendicitis were enrolled in this retrospective study. Patients were grouped according to their age: group 1: < 48 months (n = 13); group 2: > 48 months (n = 16), their clinical data, laboratory results and complications were compared. In group 1, duration of nausea and vomiting was longer, alteration of general state was more frequent and pain in the right fossa iliaca less frequent than in group 2 (p = 0.026, p = 0.000 and p = 0.029, respectively). Heart rate was higher in group 1 than in group 2 (p = 0.012). Leucocyte and polynuclear neutrophil counts were lower in group 1 than in group 2 (p = 0.028 and = 0.004, respectively) but C-reactive protein levels were not different between groups. In the whole cohort however, C-reactive protein at admission value correlated negatively with age (p = 0.025). Abdominal ultrasound allowed diagnosis in 19/29 patients (65.5%), without any difference between groups. Appendicular perforation was more frequent in group 1 than in group 2 (p = 0.003). Perforation was also related to longer hospital stay (p = 0.018). Peritonitis occurred in 21/29 (72%), post-operative ileus in 5/29 (17%) and sepsis in 4/29 (14%) patients without any difference between groups. In the whole cohort, hospital stay correlated negatively with age (p = 0.000). There was no mortality. Among preschool children, those younger than 48 months present with longer duration of pre-admission symptoms indicating longer infection course than in older children. Altered general state and higher degree of tachycardia in the younger reflect higher systemic repercussions of the illness. Less specific abdominal pain and dissociation of the inflammatory markers with lower leucocyte- and neutrophil counts and higher C-reactive protein levels in the younger may contribute to further diagnosis delay and higher rate of perforation in these patients.

中文翻译：

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年龄对学龄前儿童急性阑尾炎的临床表现，诊断延迟和结果的影响

学龄前儿童急性阑尾炎的临床表现异常会导致误诊和并发症。我们旨在分析年龄对学龄前儿童急性阑尾炎的临床表现，实验室检查结果和并发症的影响。从2012年1月至2017年12月，该回顾性研究纳入了29名6岁以下（平均50个月）的急性阑尾炎儿童。根据年龄将患者分组：第1组：<48个月（n = 13）；第2组：> 48个月（n = 16），比较了他们的临床资料，实验室检查结果和并发症。与第2组相比，第1组中的恶心和呕吐持续时间更长，一般状态的改变更为频繁，右侧窝的疼痛发生率更低（分别为p = 0.026，p = 0.000和p = 0.029）。第1组的心率高于第2组（p = 0.012）。第1组白细胞和多核中性粒细胞计数低于第2组（分别为p = 0.028和= 0.004），但各组之间C反应蛋白水平无差异。然而，在整个队列中，入院时的C反应蛋白与年龄呈负相关（p = 0.025）。腹部超声可以诊断19/29例患者（65.5％），两组之间无任何差异。第1组的阑尾穿孔比第2组的多（p = 0.003）。穿孔还与更长的住院时间有关（p = 0.018）。腹膜炎发生在21/29（72％），术后肠梗阻发生在5/29（17％），败血症发生在4/29（14％）患者之间，两组之间没有任何差异。在整个队列中，住院时间与年龄呈负相关（p = 0.000）。没有死亡。在学龄前儿童中，小于48个月的儿童出现的入院前症状持续时间较长，表明感染过程比年龄较大的儿童更长。年轻人的总体状态改变和心动过速的程度越高，反映出该疾病的全身性反应越高。较不特异性的腹部疼痛和较年轻的白细胞和中性粒细胞计数较低的炎症标志物的分离以及年轻时较高的C反应蛋白水平可能有助于这些患者的进一步诊断延迟和较高的穿孔率。