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Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study.

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Title: Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study.
Authors: Reis Wolfertstetter, Patricia, Ebert, John Blanford, Barop, Judith, Denzinger, Markus, Kertai, Michael, Schlitt, Hans J., Knorr, Christian
Source: Children; Mar2024, Vol. 11 Issue 3, p340, 14p
Subject Terms: ANTIBIOTICS, APPENDICITIS treatment, CONSERVATIVE treatment, PEDIATRIC surgery, APPENDECTOMY, ABDOMINAL pain in children, APPENDIX (Anatomy), PATIENT safety, T-test (Statistics), SCIENTIFIC observation, PILOT projects, QUESTIONNAIRES, INTERVIEWING, FISHER exact test, HOSPITAL care, TREATMENT effectiveness, RETROSPECTIVE studies, TERTIARY care, DESCRIPTIVE statistics, CHI-squared test, MANN Whitney U Test, APPENDICITIS, PEDIATRICS, MEDICAL records, ACQUISITION of data, DISEASE relapse, LENGTH of stay in hospitals, DATA analysis software, COMPARATIVE studies, PATIENT aftercare, EVALUATION
Abstract: Background: Simple appendicitis may be self-limiting or require antibiotic treatment or appendectomy. The aim of this study was to assess the feasibility and safety of a nonoperative, antibiotic-free approach for suspected simple appendicitis in children. Methods: This single-center, retrospective study included patients (0–17 years old) who were hospitalized at the pediatric surgery department due to suspected appendicitis between 2011 and 2012. Data from patients who primarily underwent appendectomy were used as controls. The follow-up of nonoperatively managed patients was conducted in 2014. The main outcome of interest was appendicitis recurrence. Results: A total of 365 patients were included: 226 were treated conservatively and 139 underwent appendectomy. Fourteen (6.2% of 226) of the primarily nonoperatively treated patients required secondary appendectomy during follow-up, and histology confirmed simple, uncomplicated appendicitis in 10 (4.4% of 226) patients. Among a subset of 53 patients managed nonoperatively with available Alvarado and/or Pediatric Appendicitis Scores and sonographic appendix diameters in clinical reports, 29 met the criteria for a high probability of appendicitis. Three of these patients (10.3% of 29) underwent secondary appendectomy. No complications were reported during follow-up. Conclusions: A conservative, antibiotic-free approach may be considered for pediatric patients with suspected uncomplicated appendicitis in a hospital setting. Only between 6 and 10% of these patients required secondary appendectomy. Nevertheless, the cohort of patients treated nonoperatively was likely to have also included individuals with further abdominal conditions other than appendicitis. Active observation and clinical support during the disease course may help patients avoid unnecessary procedures and contribute to spontaneous resolution of appendicitis or other pediatric conditions as the cause of abdominal pain. However, further studies are needed to define validated diagnostic and management criteria. [ABSTRACT FROM AUTHOR]
Copyright of Children is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Children; Mar2024, Vol. 11 Issue 3, p340, 14p
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Simple appendicitis may be self-limiting or require antibiotic treatment or appendectomy. The aim of this study was to assess the feasibility and safety of a nonoperative, antibiotic-free approach for suspected simple appendicitis in children. Methods: This single-center, retrospective study included patients (0–17 years old) who were hospitalized at the pediatric surgery department due to suspected appendicitis between 2011 and 2012. Data from patients who primarily underwent appendectomy were used as controls. The follow-up of nonoperatively managed patients was conducted in 2014. The main outcome of interest was appendicitis recurrence. Results: A total of 365 patients were included: 226 were treated conservatively and 139 underwent appendectomy. Fourteen (6.2% of 226) of the primarily nonoperatively treated patients required secondary appendectomy during follow-up, and histology confirmed simple, uncomplicated appendicitis in 10 (4.4% of 226) patients. Among a subset of 53 patients managed nonoperatively with available Alvarado and/or Pediatric Appendicitis Scores and sonographic appendix diameters in clinical reports, 29 met the criteria for a high probability of appendicitis. Three of these patients (10.3% of 29) underwent secondary appendectomy. No complications were reported during follow-up. Conclusions: A conservative, antibiotic-free approach may be considered for pediatric patients with suspected uncomplicated appendicitis in a hospital setting. Only between 6 and 10% of these patients required secondary appendectomy. Nevertheless, the cohort of patients treated nonoperatively was likely to have also included individuals with further abdominal conditions other than appendicitis. Active observation and clinical support during the disease course may help patients avoid unnecessary procedures and contribute to spontaneous resolution of appendicitis or other pediatric conditions as the cause of abdominal pain. However, further studies are needed to define validated diagnostic and management criteria. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label:
  Group: Ab
  Data: <i>Copyright of Children is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.3390/children11030340
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      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 14
        StartPage: 340
    Subjects:
      – SubjectFull: ANTIBIOTICS
        Type: general
      – SubjectFull: APPENDICITIS treatment
        Type: general
      – SubjectFull: CONSERVATIVE treatment
        Type: general
      – SubjectFull: PEDIATRIC surgery
        Type: general
      – SubjectFull: APPENDECTOMY
        Type: general
      – SubjectFull: ABDOMINAL pain in children
        Type: general
      – SubjectFull: APPENDIX (Anatomy)
        Type: general
      – SubjectFull: PATIENT safety
        Type: general
      – SubjectFull: T-test (Statistics)
        Type: general
      – SubjectFull: SCIENTIFIC observation
        Type: general
      – SubjectFull: PILOT projects
        Type: general
      – SubjectFull: QUESTIONNAIRES
        Type: general
      – SubjectFull: INTERVIEWING
        Type: general
      – SubjectFull: FISHER exact test
        Type: general
      – SubjectFull: HOSPITAL care
        Type: general
      – SubjectFull: TREATMENT effectiveness
        Type: general
      – SubjectFull: RETROSPECTIVE studies
        Type: general
      – SubjectFull: TERTIARY care
        Type: general
      – SubjectFull: DESCRIPTIVE statistics
        Type: general
      – SubjectFull: CHI-squared test
        Type: general
      – SubjectFull: MANN Whitney U Test
        Type: general
      – SubjectFull: APPENDICITIS
        Type: general
      – SubjectFull: PEDIATRICS
        Type: general
      – SubjectFull: MEDICAL records
        Type: general
      – SubjectFull: ACQUISITION of data
        Type: general
      – SubjectFull: DISEASE relapse
        Type: general
      – SubjectFull: LENGTH of stay in hospitals
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      – SubjectFull: DATA analysis software
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      – SubjectFull: COMPARATIVE studies
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      – SubjectFull: PATIENT aftercare
        Type: general
      – SubjectFull: EVALUATION
        Type: general
    Titles:
      – TitleFull: Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study.
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              M: 03
              Text: Mar2024
              Type: published
              Y: 2024
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