Strikwerda, Bram (2025) Male sex is associated with delayed diagnosis of pediatric appendicitis: A retrospective cohort study in primary care. thesis, Medicine.
Full text available on request.Abstract
Background: Acute appendicitis is the most common indication for abdominal surgery in children, yet its recognition in primary care is challenging. Approximately 20% of children with appendicitis are not referred during their first consultation at the general practitioner (GP), while 69% of children referred for acute abdominal pain are proven not to have appendicitis. Delayed diagnoses increase the risk of perforation, whereas non-appendicitis referrals place a burden on patients and the healthcare system. Objective: To identify demographic and clinical predictors of delayed appendicitis diagnosis and non-appendicitis referrals in children presenting with acute abdominal pain in primary care. Methods: We conducted a retrospective cohort study including 5,691 children aged 4–18 years presenting at the GP with acute abdominal pain between 2010 and 2016. Multinomial logistic regression was used to assess associations between candidate predictors and either delayed diagnosis or non-appendicitis referral. Results: Male sex was positively associated with delayed diagnosis, compared to both children without appendicitis and those with a timely diagnosis (aOR: 3.85; 95% CI: 2.08–7.14 and aOR: 2.00; 95% CI: 1.00–4.00, respectively). Male sex (aOR: 0.47; 95% CI: 0.35–0.63), older age (aOR: 0.63; 95% CI: 0.43–0.94 for 13-18 years), nausea/vomiting (aOR: 0.49; 95% CI: 0.32–0.74), and RLQ tenderness (aOR: 0.43; 95% CI: 0.24–0.74) were negatively associated with a non-appendicitis referral. Conclusions: Boys were more likely to receive a delayed diagnosis of appendicitis. Among referred children, male sex, older age, nausea or vomiting and RLQ tenderness decreased the likelihood of a non-appendicitis diagnosis.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Burger, Dr. H. and Hogervorst, Drs. E.M. (MSc) |
| Faculty: | Medical Sciences |
| Date Deposited: | 11 May 2026 12:32 |
| Last Modified: | 11 May 2026 12:32 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3948 |
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