Clinical, Laboratory and Imaging Predictors of Complicated Appendicitis in Children: A Multivariate Analysis

Abstract Objective To identify clinical, laboratory, and imaging factors associated with complicated appendicitis in a Mexican pediatric population using multivariate analysis. Methods This retrospective, observational, analytical, cross-sectional study was conducted at a tertiary care hospital in Mexico City. A total of 134 patients under 18 years of age with a histopathological diagnosis of acute appendicitis were included from January 2019 and March 2024. Cases presenting with gangrene, perforation, or abscess were classified as complicated appendicitis. Clinical, laboratory, and imaging variables were analyzed using bivariate and multivariate logistic regression. Results Complicated appendicitis was present in 28.3% of patients. In multivariate analysis, fever at admission (OR 5.58, 95% CI: 1.89–16.42, p = 0.002), band cell percentage (OR 1.22, 95% CI: 1.09–1.36, p = 0.001), hyponatremia (OR 0.75, 95% CI: 0.60–0.92, p = 0.004), and presence of an appendicolith (OR 1.42, 95% CI: 1.10–1.83, p = 0.006) were significantly associated with complicated cases. Conclusion Simple and readily available variables at hospital admission—such as fever, serum sodium levels, bandemia, and the presence of an appendicolith—can aid in stratifying the risk of complicated appendicitis in children, facilitating more timely and targeted diagnostic and therapeutic decisions.