Abstract：
BACKGROUND: Acute appendicitis is the most common aetiology of acute abdomen in children. Our aim is to describe the accuracy of diagnosis, and complications in a limited resources setting in children between 5 and 14 years old at the only tertiary referral hospital in the West region of Afghanistan.
METHODS: A retrospective study for a period of 1 year (21 March 2015-20 March 2016). Data was collected from patients\' files. Data were analysed by epi info 7.
RESULTS: We identified 774 children who had appendectomies at Herat Regional Hospital during the study period with complete records available for analysis. The median age was 11 years [5-14]. The rate of positive appendectomy was 87%. 72% of appendectomies were done within 24 h of the onset of symptoms. Of 675 positive appendectomies, the most common clinical features were migratory abdominal pain (90%), nausea/vomiting (80%), RLQ tenderness (90%), and rebound tenderness (81%). Among the 99 negative appendectomies, the most common signs and symptoms were anorexia 68%, nausea/vomiting 59%, RLQ tenderness 79%, and rebound tenderness 43%. 98% of positive and 71% of negative appendectomies had elevated WBC count. Post appendectomy complications occurred in 9% of our patients mostly commonly intra-abdominal abscesses (5%).
CONCLUSIONS: Although the diagnosis of acute appendicitis is challenging in children and may involve sophisticated imaging techniques, in many settings these are unavailable. Classical manifestations such as migratory abdominal pain, abdominal tenderness, nausea, and simple lab tests play a crucial role in the diagnosis of acute appendicitis in low resource environments.
METHODS: A retrospective study for a period of 1 year (21 March 2015-20 March 2016). Data was collected from patients\' files. Data were analysed by epi info 7.
RESULTS: We identified 774 children who had appendectomies at Herat Regional Hospital during the study period with complete records available for analysis. The median age was 11 years [5-14]. The rate of positive appendectomy was 87%. 72% of appendectomies were done within 24 h of the onset of symptoms. Of 675 positive appendectomies, the most common clinical features were migratory abdominal pain (90%), nausea/vomiting (80%), RLQ tenderness (90%), and rebound tenderness (81%). Among the 99 negative appendectomies, the most common signs and symptoms were anorexia 68%, nausea/vomiting 59%, RLQ tenderness 79%, and rebound tenderness 43%. 98% of positive and 71% of negative appendectomies had elevated WBC count. Post appendectomy complications occurred in 9% of our patients mostly commonly intra-abdominal abscesses (5%).
CONCLUSIONS: Although the diagnosis of acute appendicitis is challenging in children and may involve sophisticated imaging techniques, in many settings these are unavailable. Classical manifestations such as migratory abdominal pain, abdominal tenderness, nausea, and simple lab tests play a crucial role in the diagnosis of acute appendicitis in low resource environments.
摘要：
背景：急性阑尾炎是儿童急腹症最常见的病因。我们的目的是描述诊断的准确性，在阿富汗西部地区唯一的三级转诊医院中，5至14岁的儿童在资源有限的情况下出现并发症。
方法：一项为期1年的回顾性研究（2015年3月21日至2016年3月20日）。数据是从患者档案中收集的。通过epiinfo7分析数据。
结果：我们确定了774名在赫拉特地区医院接受阑尾切除术的儿童，其完整记录可用于分析。中位年龄为11岁[5-14]。阑尾切除术的阳性率为87％。72%的阑尾切除术是在症状出现后24小时内完成的。在675例阳性阑尾切除术中，最常见的临床特征是偏头痛（90％），恶心/呕吐（80%），RLQ压痛（90%），和回弹压痛(81%)。在99例阴性阑尾切除术中，最常见的体征和症状是厌食症68%，恶心/呕吐59%,RLQ压痛79%,回弹压痛43%。98％的阳性和71％的阴性阑尾切除术的白细胞计数升高。9％的患者发生阑尾切除术后并发症，主要是腹腔脓肿（5％）。
结论：尽管儿童急性阑尾炎的诊断具有挑战性，并且可能涉及复杂的成像技术，在许多设置这些是不可用的。经典表现，如偏头痛，腹部压痛,恶心,简单的实验室检查在低资源环境下诊断急性阑尾炎中起着至关重要的作用。
方法：一项为期1年的回顾性研究（2015年3月21日至2016年3月20日）。数据是从患者档案中收集的。通过epiinfo7分析数据。
结果：我们确定了774名在赫拉特地区医院接受阑尾切除术的儿童，其完整记录可用于分析。中位年龄为11岁[5-14]。阑尾切除术的阳性率为87％。72%的阑尾切除术是在症状出现后24小时内完成的。在675例阳性阑尾切除术中，最常见的临床特征是偏头痛（90％），恶心/呕吐（80%），RLQ压痛（90%），和回弹压痛(81%)。在99例阴性阑尾切除术中，最常见的体征和症状是厌食症68%，恶心/呕吐59%,RLQ压痛79%,回弹压痛43%。98％的阳性和71％的阴性阑尾切除术的白细胞计数升高。9％的患者发生阑尾切除术后并发症，主要是腹腔脓肿（5％）。
结论：尽管儿童急性阑尾炎的诊断具有挑战性，并且可能涉及复杂的成像技术，在许多设置这些是不可用的。经典表现，如偏头痛，腹部压痛,恶心,简单的实验室检查在低资源环境下诊断急性阑尾炎中起着至关重要的作用。
