Comparative Study of Appendicitis in Preschool and School-Age Children: Clinical Features and Outcomes.

Appendicitis is one of the most common causes of abdominal pain requiring surgical intervention in children. This study aims to compare the clinical features, diagnostic accuracy, and outcomes of appendicitis in preschool-aged and school-aged children using the Pediatric Appendicitis Score (PAS) and Alvarado Score. This prospective comparative study was conducted in the Department of Pediatric Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2023 to July 2024, including 386 children diagnosed with appendicitis. The cohort consisted of 86 preschool-aged children (<6 years) and 300 school-aged children (6-14 years). Clinical presentation, diagnostic scores (PAS and Alvarado), and outcomes were analyzed. Preschool-aged children presented with delayed diagnosis and more severe clinical features, including higher rates of perforation (58.0%) compared to school-aged children (32.0%). The mean PAS and Alvarado scores were lower in preschool children, leading to challenges in early recognition. In contrast, school-aged children demonstrated more consistent symptomatology, allowing for earlier diagnosis and intervention. Despite similar management protocols, preschool children experienced higher complication rates and longer hospital stays (mean: 7.2 days) compared to school-aged children (mean: 4.5 days). Preschool-aged children are more vulnerable to severe appendicitis due to delayed diagnosis and atypical presentations. This study highlights the need for heightened clinical suspicion and the potential refinement of diagnostic scoring systems to improve early detection and outcomes in younger children.