Using shock index, pediatric age adjusted (SIPA) to predict prolonged length of stay in perforated appendicitis: a retrospective review
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Nov 2024 · 1 min read
In brief
In brief
This retrospective study demonstrates that elevated Shock Index, Pediatric Age Adjusted (SIPA) at presentation reliably predicts perforated appendicitis and prolonged hospital stays in children. Patients with elevated SIPA had over 5 times higher odds of perforation and significantly longer recovery times, supporting SIPA's use in triage and family counseling.
- Elevated SIPA at presentation increases odds of perforated appendicitis 5.4-fold in pediatric patients (95% CI: 2.3-13.8).
- Children with elevated SIPA have 2× longer hospital stays and 5× longer time to tolerate regular diet post-appendectomy.
- SIPA can be used during triage to identify high-risk appendicitis cases and set realistic family expectations for recovery.
- Time to SIPA normalization correlates with duration of antibiotic therapy (1.8× longer in elevated SIPA group).
- SIPA, originally validated in trauma and ICU settings, shows clinical utility for risk stratification in acute appendicitis.
Written by the GCMD Library team from the article.
Abstract
Purpose
Hospital length of stay (LOS) following admission for appendicitis is difficult to predict. Shock index, pediatric age adjusted (SIPA) accurately identifies severely injured trauma patients and predicts mortality among children admitted to the ICU. Our aim was to determine if elevated SIPA at presentation, and time to normalization of SIPA, can identify children with perforated appendicitis and predict hospital LOS.
Methods
This was a retrospective cohort study of children 1–17 years admitted to a quaternary care referral center with appendicitis after appendectomy in 2021. The primary outcomes were presence of perforated appendicitis and hospital LOS. Generalized linear regressions were performed. Covariates included in all models were age, sex, fecalith, initial temperature, and time from diagnosis to OR.
Results
We included 169 patients; 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.
Conclusion
In children with appendicitis, elevated SIPA at presentation is associated with higher risk of perforation. These findings support the incorporation of SIPA during triage of patients with appendicitis and counseling families after surgery.
Level of evidence
Level 3.