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Quick Literature Updates Ep 26

Video Published 2026-01-22 Updated 2026-06-10

Timestops (3)

Appendicectomy vs Antibiotics for Appendicitis

VACTERL Screening in Anorectal Malformations

Sepsis Definitions and Mortality Rates

Topic Overview

A rapid literature review covering three recent pediatric surgery studies. The first compares appendectomy versus antibiotic treatment for uncomplicated appendicitis in children, finding that 34% of antibiotic-treated patients required surgery within a year versus 7% in the surgery group, failing to meet non-inferiority criteria. The second examines associated anomalies in anorectal malformations using the PHIS database, finding cardiac (77.4%), vertebral-spinal (45.4%), renal (39.9%), and gynecologic (25.8% of females) anomalies most common, proposing a new VACTERL-GS acronym. The third presents updated international consensus definitions for pediatric sepsis using the Phoenix sepsis score, with sepsis defined as suspected infection plus 2 points and septic shock requiring additional cardiovascular dysfunction, associated with 7.1% and 10.8-33.5% mortality respectively.

Key Takeaways

Antibiotics failed non-inferiority for pediatric appendicitis: 34% required surgery within 1yr vs 7% in appendectomy group (1:24)
ARM screening should include cardiac (77%), vertebral-spinal (45%), renal (40%), and gynecologic (26% of females) anomalies (2:25)
Phoenix sepsis score defines sepsis as infection + 2pts; septic shock adds cardiovascular dysfunction (mortality 7.1% vs 11-34%) (3:48)

Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Em Gdy — host
Lizzie Lee — guest
Alex Halpern — guest
Cecilia Jhena — guest

Chapters

0:00Introduction and Appendicitis Treatment Study — Host introduces the episode and first paper comparing appendectomy versus antibiotics for uncomplicated appendicitis in children, summarized by Lizzie Lee.
1:51VACTERL Screening in Anorectal Malformations — Second paper on associated anomalies in ARM patients using PHIS database, proposing updated screening acronym VACTERL-GS, summarized by Alex Halpern.
3:01Pediatric Sepsis Consensus Definitions — Third paper presenting international consensus criteria for pediatric sepsis and septic shock using Phoenix sepsis score, summarized by Cecilia Jhena, followed by closing remarks.

Key claims

1:07Recent literature has been supporting treating appendicitis with antibiotics rather than surgery — Lizzie Lee
1:12The appendicitis study was a multi-center randomized trial conducted in Canada, the US, Finland, Sweden, and Singapore — Lizzie Lee
1:2434% of children treated with antibiotics for appendicitis eventually required surgery within a year — Lizzie Lee
1:24Only 7% in the appendectomy group required additional surgery within a year — Lizzie Lee
1:32There were no deaths in either the antibiotic or surgery group for appendicitis treatment — Lizzie Lee
1:32Children in the antibiotic group had a higher risk of mild to moderate adverse events compared to surgery group — Lizzie Lee
1:39Antibiotics were not as effective as surgery for treating non-perforated appendicitis in children and did not meet the threshold for non-inferiority — Lizzie Lee
2:16The ARM study used the PHIS database and included all ARM patients between 2016 and 2022 — Alex Halpern
2:25In ARM patients, vertebral-spinal anomalies were diagnosed in 45.4% across all hospital encounters — Alex Halpern
2:25In ARM patients, cardiac anomalies were diagnosed in 77.4% across all hospital encounters — Alex Halpern
2:25In ARM patients, TEF was diagnosed in 10.2% across all hospital encounters — Alex Halpern
2:25In ARM patients, renal anomalies were diagnosed in 39.9% across all hospital encounters — Alex Halpern
2:25In ARM patients, limb anomalies were diagnosed in 15.7% across all hospital encounters — Alex Halpern
2:4025.8% of female ARM patients had a congenital gynecologic malformation diagnosed — Alex Halpern
2:45The most common anomalies associated with ARMs are cardiac, vertebrospinal, renal, and gynecologic — Alex Halpern
2:53The authors suggest changing the VACTERL acronym to VACTERL-GS to include gynecologic and spinal conditions — Alex Halpern
3:20The sepsis study was a worldwide study with a Delphi consensus process that aimed to update the definitions of sepsis and septic shock — Cecilia Jhena
3:29The Phoenix sepsis score includes variables in cardiovascular function, respiratory function, coagulation, and neurological function — Cecilia Jhena
3:42The Phoenix sepsis score correlates the definition with actual mortality rate — Cecilia Jhena
3:48Sepsis is defined as suspected infection plus 2 points in the Phoenix sepsis score — Cecilia Jhena
3:48Septic shock is defined as sepsis plus cardiovascular dysfunction seen when there is 1 point in the cardiovascular variable of the Phoenix sepsis score — Cecilia Jhena
4:06Sepsis has a mortality rate of 7.1% — Cecilia Jhena
4:06Septic shock has a mortality rate of 10.8 to 33.5% according to the research settings — Cecilia Jhena

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Keywords

acute uncomplicated appendicitis non-perforated appendicitis anorectal malformations vertebral anomalies spinal anomalies cardiac anomalies tracheo-esophageal fistula renal anomalies limb anomalies congenital gynecologic malformation sepsis septic shock cardiovascular dysfunction appendicectomy VACTERL screening

Hashtags

#PediatricSurgery #MedicalEducation #SurgicalLiterature #PediatricCare #PediatricSepsis #VACTERL #Appendicitis

Transcript

Hello pediatric surgery family, I'm Em Gdy from Cincinnati Children's Hospital Medical Center, and today our team is gonna deliver the articles that you should know about. We have 3 papers today, but don't have much time, so let's start. Our first paper titled Appendicectomy versus Antibiotics for Acute uncomplicated Appendicitis in Children, an Open label International multi-enter randomized non-inferiority trial by Saint Peter et al. This paper is summarized by Lizzie Lee, a physician associate by profession and a member of our team here at Cincinnati Children's dedicated to creating content for pediatric surgery. Recent literature has been supporting treating appendicitis with antibiotics rather than surgery. This is a multi-center randomized trial in Canada, the US, Finland, Sweden, and Singapore that investigated whether antibiotic treatment is inferior to appendicectomy by comparing failure rates for the two options. They found that 34% of children treated with Antibiotics eventually required surgery within a year compared to only 7% in the surgery group. While there were no deaths in either group, children in the antibiotic group had a higher risk of mild to moderate adverse events. The key takeaway is that antibiotics were not as effective as surgery for treating non-perforated appendicitis in children, as it did not meet the threshold for non-inferiority. Our second paper is Vactal screening in newborns with anorectal malformations, an opportunity to optimize screening practices at gynecologic and spinal conditions and utilize a new acronym by SH et al. And this paper is summarized by Alex Halpern. He is a research fellow at Children's National and collaborates with us to produce these article reviews. To try and answer this question, Zoo Aal used the PIS database and performed a multi-institutional cohort study of all ARM patients between 2016 and 2022. The rates of actual diagnoses across all hospital encounters were 45.4% vertebral spinal, 77.4% cardiac, 10.2% TEF, 39, 0.9% renal and 15.7% limb. 25.8% of female patients had a congenital gynecologic malformation diagnosed. So it seems like the most common anomalies associated with ARMs are cardiac, vertebrospinal, renal, and gynecologic. Due to this, the authors suggest changing the Vacto acronym to Vector Gs. Let's move to the last paper of the day. International Consensus Criteria for Pediatric sepsis and septic Shock by Schlappbach et al. This paper is summarized by Cecilia Jhena. She's one of the previous research fellows at Cincinnati Children's Hospital. This is a worldwide study with a Delphi consensus process that aimed to update the definitions of sepsis and septic shock. After multiple analysis, they came up with a Phoenix sepsis score that included variables in cardiovascular function, respiratory function, coagulation, and neurological function. This helped the author correlates the definition with an actual mortality rate. So for sepsis, the definition is suspected infection plus 2 points in the Phoenix sepsis score, and septic shock is sepsis plus cardiovascular dysfunction that is seen when we have 1 point in the cardiovascular variable of the Phoenix sepsis score. Sepsis mental mortality of 7.1%, whereas septic shock imply 10.8 to 33.5% according to the research settings. Thank you for listening. Please check the link in the description below to read each paper. We hope you liked this episode. Please follow Stay Current MD on social media. Give us a rating, and subscribe to our YouTube channel. And don't forget to download the Stay Current app on the App Store or Play Store for tons of content.

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