The Comparisons of the Management and Pain Control for Appendicitis between Adults and Children in the Emergency Department

ABSTRACT

PURPOSE: Appendicitis is one of the most common causes of acute abdominal pain presenting to the emergency department (ED). Emergency physicians are responsible for correct diagnosis and management of pain associated with appendicitis before surgery. We analyzed the comparison of management and pain control for appendicitis between adults and children in the ED. METHODS: This study was a retrospective case control study, conducted in two EDs of a teaching hospital from 2011 to 2012. Patients who were diagnosed as appendicitis based on the radiologic modality were enrolled. We analyzed the clinical characteristics of the patients, who were adults and children diagnosed with appendicitis, respectively. We also analyzed the predictors of pain control for the appendicitis patients by multiple logistic regression. RESULTS: A total of 2,130 patients were enrolled during a two-year period. The median age of the patients was 33 years (IQR 19~47) and 22.8% of patients were under 18 years of age; 54.6% were men. Ultrasonography was performed on 10.8% of patients and computed tomography (CT) on 89.4%. Significant difference in overall pain management was observed between children and adults (adult 29.5% vs children 20.6%, p=0.001). Adult patients younger than 65 years old, male, and those who underwent CT scan received more analgesics than others. Significant difference of the type of analgesics was observed between adults patients and pediatric patients. The use of analgesics did not affect the outcome, such as complication, unplanned revisit. CONCLUSION: Both adults and children with acute appendicitis still did not receive enough pain medication in the ED, even after being diagnosed.