Switching lanes: No home antibiotics or laboratory testing prior to discharge in perforated appendicitis
Topic overview
This study examines a protocol change eliminating routine white blood cell testing and home antibiotics at discharge for children with perforated appendicitis. The previous approach used WBC ≥10 as a trigger for outpatient antibiotics, with an 8% intra-abdominal abscess rate, prompting evaluation of a simplified discharge strategy.
Key takeaways
- Perforated appendicitis affects ~30% of pediatric appendicitis cases, defined by hole in appendix or free fecalith at surgery.
- Previous protocol: discharge WBC ≥10 triggered outpatient oral antibiotics; baseline IAA rate was 8%.
- New protocol (May 2023): eliminated discharge WBC testing and routine outpatient antibiotics without increasing complications.
- De-implementation strategy reduced unnecessary lab draws and antibiotic exposure in perforated appendicitis management.
- Discharge WBC may not predict post-op abscess risk; clinical assessment alone appears sufficient for safe discharge.
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How to cite: GlobalCastMD. Switching lanes: No home antibiotics or laboratory testing prior to discharge in perforated appendicitis. GlobalCastMD Medical Library. 2025-08-12. https://library.globalcastmd.com/article/10793
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