The Effect Of First-visit Medical Mode And Raise Mode On Perforation Rate And Misdiagnosis Rate Of Appendicitis In Children

objective:To analyze the changes of perforation rate and misdiagnosis rate of appendicitis in children in recent ten years,and to analyze the effects of different first-visit medical mode and raise mode on perforation and misdiagnosis of appendicitis in children.Methods:The surgical treatment and according to the intraoperative and postoperative pathologic results the final diagnosis of pediatric appendicitis cases of basic information,including the year of treatment,age,gender,perforated appendix is occurring,whether to have misdiagnosed experience,the first-visit medical mode(first option in tertiary hospital,the first option in the non-tertiary hospitals),the raise mode(parental rearing,single parenting,others)and the usage of abdominal ultrasound,CT examination.To analyze the change trend of perforation rate and misdiagnosis rate of acute appendicitis in children in recent ten years,and to compare the influence of different factors on the perforation rate and misdiagnosis rate of acute appendicitis in children.Results:1.The perforation rate and misdiagnosis rate of appendicitis in children during the 10 years:(1)From January 2008 to December 2017,a total of 1,839 cases of pediatric acute appendicitis met the inclusion and exclusion criteria.According to the intraoperative findings and postoperative pathological results of the surgeons,594 cases of appendicitis perforation were confirmed,with a total perforation rate of 32.3%,680 cases of misdiagnosis of the first diagnosis and a total misdiagnosis rate of 37.0%.The perforation rate and misdiagnosis rate did not decrease year by year.(2)The perforation rate and misdiagnosis rate of pediatric appendicitis are closely related to the age of the children.The perforation rate of newborns and infants aged 0-3 years(64.8%)is significantly higher than that of the preschool group(43.8%)and the school-age group(15.4%).After statistical analysis by year,it was found that perforation rate of children with appendicitis in the age group of 0-3 years old and 4-7 years old did not decrease year by year,while perforation rate of children with appendicitis in the age group of 8-14 years old showed a decreasing trend year by year.The misdiagnosis rate of newborns and infants aged 0-3 years(66.4%)was significantly higher than that of the preschool group(45.3%)and the school-age group(23.2%).After statistical analysis by year,the misdiagnosis rate in the group aged 8-14 years showed no downward trend year by year.2.The influence of the first-visit medical mode on the perforation rate and misdiagnosis rate of children’s appendiciti:(1)Of the 1839 cases of pediatric appendicitis,648 cases(35.2%)were first diagnosed in tertiary hospitals,and 1191 cases(64.8%)were first diagnosed in non-tertiary hospitals.According to the analysis of five groups by year,it was found that the cases of acute appendicitis in children first diagnosed in tertiary hospitals presented a declining trend,while the cases of acute appendicitis in children first diagnosed in non-tertiary hospitals presented an increasing trend year by year.(2)Perforation rate and misdiagnosis rate(40.8%,47.4%)in the first diagnosis group of non-tertiary hospitals were significantly higher than those in the first diagnosis group of tertiary hospitals(16.7%,17.7%).Statistical analysis by year showed that the perforation rate and misdiagnosis rate of children’s appendicitis in the first treatment group of non-tertiary hospitals in each year were higher than those in the first treatment group of tertiary hospitals.However,the perforation rate and misdiagnosis rate did not decrease year by year in both tertiary hospitals and non-tertiary hospitals.(3)The perforation rate of appendicitis first diagnosis in non-tertiary hospitals in all age groups was higher than that in tertiary hospitals,and the rate of appendicitis perforation in groups 0-3 years old and 4-7 years old was especially higher than that in tertiary hospitals.(4)The misdiagnosis rate of pediatric appendicitis at the first diagnosis in tertiary hospitals and non-tertiary hospitals decreased with age,but the misdiagnosis rate of 8-14 years old school-age children at the first diagnosis in non-tertiary hospitals was also significantly higher than that at tertiary hospitals.3.Use of auxiliary examinations(abdominal b-ultrasound,abdominal CT):(1)In this group,the use rate of b-ultrasound and CT examination in the first diagnosis group of tertiary hospitals was higher than that of non-tertiary hospitals,and the sensitivity of b-ultrasound and CT examination in the first diagnosis group of tertiary hospitals was higher than that of non-tertiary hospitals.(2)The annual grouping analysis of abdominal b-ultrasound and CT examination of children with appendicitis in the past 10 years showed that the application rate of b-ultrasound for first diagnosis in non-tertiary hospitals increased year by year,and was close to that in tertiary hospitals from 2016 to 2017.However,the application rate of CT was still very low in the first diagnosis group of non-tertiary hospitals.(3)Abdominal b-ultrasound and CT examination of children with appendicitis for 10 years were analyzed by age group,and it was found that the first diagnosis in tertiary hospitals had a higher rate of b-ultrasound application in older children,while CT was used mostly in low age group,and the first diagnosis in non-tertiary hospitals had lower rate of b-ultrasound and CT examination in the all age groups.4.The influence of raise mode on perforation rate and misdiagnosis rate of children’s appendicitis:(1)In this group of 1839 children with acute appendicitis,parental rearing was the main mode of care(71.78%).There was no significant change in the composition of raise modes during the 10 years.(2)All cases were statistically analyzed according to different raise mode,and it was found that there was no statistically significant difference in perforation rate of acute appendicitis in children.Further stratified statistical analysis by age showed that the perforation rate of appendicitis showed a decreasing trend with the increase of children’s age under the three modes of care,while the perforation rate of the younger age group under the other modes was significantly higher than that of the two-parent care group and the single-parent care group.(3)The misdiagnosis rate of the first diagnosis of other parenting modes was 45.8%,higher than that of 35.1% of parents and 38.4% of single parents.Further stratified statistical analysis by age showed that the misdiagnosis rate of the first diagnosis of appendicitis in the group aged 0-3 years under the three modes of care was high,and it decreased with the increase of the age of the children.However,the misdiagnosis rate of the first diagnosis in the group aged 4-7 years under the other modes of care was still significantly higher than that in the group of two-parent care and single-parent care.(4)In this group of 1839 cases of children with different treatment modes,the first visit to tertiary hospitals was significantly higher in the parental care group than in the single parent care group and other care groups.Conclusions:1.There was no significant change in the incidence of perforation and misdiagnosis rate of acute appendicitis in children in the past decade.2.The perforation rate and misdiagnosis rate of acute appendicitis in children can be affected to different degrees by different first-visit mode and raise mode.3.The hospital with the first diagnosis as a tertiary hospital and the two-parent raising mode can significantly reduce the perforation rate and misdiagnosis rate of acute appendicitis in children.4.Abdominal b-ultrasound and CT examination are helpful for the diagnosis of pediatric appendicitis and can effectively reduce the incidence of appendicitis perforation and misdiagnosis.Non-tertiary hospitals are recommended to increase the utilization rate of abdominal CT examination for children suspected of appendicitis,especially for children aged 0-7 years.5.0-7 years old children should be raised by both parents,and the tertiary hospital should be selected as the first hospital for diagnosis,which will reduce the possibility of acute appendicitis perforation and misdiagnosis.