J. W. Nielsen1, V. Pepper1, B. D. Kenney1 1Nationwide Children’s Hospital,Pediatric Surgery,Columbus, OH, USA
Introduction: Appendicitis is a common surgical disease in children. Several other pathologies can mimic appendicitis in children including mesenteric adenitis which has been associated with pharyngitis. We sought to further understand the link between appendicitis-like symptoms and another common childhood disease, streptococcal (strep) pharyngitis.
Methods: All patients undergoing ultrasound imaging for appendicitis in our emergency department during 2013 were reviewed (n=1572). A total of 207 patients were identified who underwent both ultrasound for appendicitis and testing for strep pharyngitis (rapid strep test with reflex PCR test if negative). Demographic and outcomes data between rule out appendicitis patients who underwent strep testing and those who did not were compared. Chi- square and Fisher's exact tests were performed on categorical variables and T-tests were used for continuous variables with p<0.05 being considered significant.
Results: Strep testing was more common in younger patients (mean age=8.26 years vs. 10.26 years p<0.001) and evenly matched by gender (104 male, 103 female). Of the 207 patients tested for strep pharyngitis only 8 patients had appendicitis and only 35 (16.9%) patients tested positive for strep pharyngitis. There were no patients identified who tested positive for both strep pharyngitis and had appendicitis. Five negative appendectomies were performed in the strep pharyngitis tested group for a negative appendectomy rate of (5/13) 38.5%, compared to 7.7% (23/296) (p=0.003) in the non-test group. Two of the patients with negative appendectomies in the strep testing group had positive strep tests and the remaining 3 were negative. The appendicitis rate among the strep testing group was lower at 3.8% (8/207) compared to 20% (273/1365) in the non-tested group (p<0.001).
Conclusions: Patients undergoing testing for strep pharyngitis were more likely to be young. Strep testing was also associated with much lower rates of appendicitis and higher negative appendectomy rates. No patients undergoing strep testing were positive for both appendicitis and strep pharyngitis. In cases where patients have sufficient symptoms to warrant testing for strep pharyngitis a diagnosis of appendicitis is less likely. The low rates of positive strep tests and appendicitis suggest that patients with abdominal pain and symptoms of pharyngitis most likely have a viral illness that in most cases does not warrant additional testing. Prudence must be exercised to correctly diagnose pathology and to avoid unnecessary testing.