A. Barone-Camp2, A. Louiselle2, S. Bothwell3, J. Diaz-Miron1,2,3, J. Hills-Dunlap1,2,3, S. Acker1,2,3, A. Gosain1,2,3 1Children’s Hospital Colorado, Pediatric Surgery, Aurora, CO, USA 2University of Colorado School of Medicine, Surgery, Aurora, CO, USA 3Children’s Hospital Colorado, Center For Children’s Surgery, Aurora, CO, USA
Introduction: Hospital length of stay (LOS) following admission for appendicitis is difficult to predict. Shock index, pediatric age adjusted (SIPA) has previously been shown to accurately identify severely injured trauma patients and predict mortality among children admitted to the ICU. The aim of this study was to determine if an elevated SIPA at presentation, and time to normalization of SIPA, can identify children with perforated appendicitis and predict hospital LOS.
Methods: We performed a retrospective cohort study of children 1-17 years admitted to a tertiary referral center with appendicitis after appendectomy in 2021. Elevated SIPA was defined as greater than 1.22 for 1-6 years of age, greater than 1 for 7-12 years of age, and greater than 0.9 for 13-17 years of age. The primary outcomes were presence of perforated appendicitis and hospital LOS. Secondary outcomes included time to tolerate regular diet, unplanned ED visit within 30 days of discharge, and total antibiotic duration. Generalized linear regressions were performed. Covariates included in all models were age, sex, fecalith, initial temperature, and time from diagnosis to OR.
Results: 169 patients were included; 53 (31.4%) had perforated appendicitis. After adjustment, elevated SIPA was associated with presence of perforated appendicitis (p = 0.0002) and longer LOS (p < 0.0001). A patient presenting with appendicitis and elevated SIPA had 5.447 times higher odds of having perforated appendicitis (95% CI: 2.262, 13.826), a mean hospital LOS 2.047 times longer (95% CI: 1.564, 2.683), a mean time to toleration of regular diet 4.995 times longer (95% CI: 2.914, 8.918), and a mean duration of antibiotics that is 1.761 times longer (95% CI: 1.383, 2.243) than a patient with normal SIPA. After adjustment, there was a significant association between multiple outcomes and time to normalization of SIPA. For each additional hour a patient takes to normalize SIPA, the predicted mean hospital LOS increases by a factor of 1.017 days (95% CI: 1.008, 1.025), the mean duration of antibiotics increased by a factor of 1.0014 days, (95% CI: 1.006, 1.022), the mean time to toleration of regular diet increases by a factor of 1.03 days (95% CI: 1.014, 1.046), and the odds of experiencing an unplanned ED visit within 30 days is 1.061 times higher (95% CI: 1.007, 1.119). After adjustment, there was not a significant association between race/ethnicity and elevated SIPA, hospital LOS, or perforation.
Conclusion: Elevated SIPA at presentation is associated with perforated appendicitis. Each additional hour it takes for a patient to normalize SIPA is associated with longer LOS, antibiotic duration, and time to toleration of feeds. These findings support the utility of SIPA as a preoperative marker to consider when determining management strategies and how to counsel families regarding expected LOS.