Acute appendicitis in children: Reexamining indications for conservative treatment – a large prospective analysis
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Read the article on jpedsurg.org ↗Article · Dec 2021 · 1 min read
In brief
In brief
Large prospective study of 646 children with uncomplicated acute appendicitis treated conservatively found 79% success rate, with 28% experiencing recurrence. Older age, larger appendiceal diameter, and elevated WBC counts predicted treatment failure and need for appendectomy, informing a clinical decision tree for patient selection.
Written by the GCMD Library team from the article.
Introduction: Conservative antibiotic treatment (CAT) for uncomplicated acute appendicitis (AUA) in children has been proven safe and efficacious. However, as data accumulate, high rates of recurrent appendicitis and subsequent appendectomy have been reported. This prospective longitudinal study evaluated risk-factors for recurrent AUA after CAT in a large cohort, with long-term follow-up.
Materials and methods: Children ages 5 to 16 years admitted to the Department of Pediatric Surgery from 2014 through 2018, diagnosed with AUA were eligible for CAT. We recorded their age, appendix outer diameter, white blood cell counts, C-reactive protein and other related signs and symptoms associated with AUA. Clinical and ultrasonographic follow-up was carried out until follow-up data collection ceased according to the study design (2014-2019).
Results: The cohort included 646 children who were initially treated successfully with CAT. Among them, 180 (28 %) were readmitted for recurrent acute appendicitis during the follow-up period and 138 (21%) eventually had appendectomy. Overall success of 79% for CAT was recorded in this cohort. A multivariable model including; age, sex, appendiceal diameter, WBC and CRP, found the factors of older age, larger outer appendiceal diameter and high WBC counts significantly related to appendectomy during the follow-up period. We offer a decision tree model to predict appendectomy probabilities for patients based on their prognostic measurements.
Conclusion: CAT in AUA in children should consider older age, larger outer appendiceal diameter and high WBC counts as risk-factors for recurrent AUA and subsequent appendectomy. The proposed decision tree model may help both clinicians and parents before CAT is chosen.