Appendicitis treatment, VACTERL screening updates, and new pediatric sepsis criteria

Recent literature has been supporting treating appendicitis with antibiotics rather than surgery

The Saint Peter et al. trial was a multi-center randomized trial in Canada, the US, Finland, Sweden, and Singapore investigating whether antibiotic treatment is inferior to appendectomy

34% of children treated with antibiotics eventually required surgery within a year compared to only 7% in the surgery group

There were no deaths in either the antibiotic or surgery group for uncomplicated appendicitis

Children in the antibiotic group had a higher risk of mild to moderate adverse events compared to the surgery group

Antibiotics were not as effective as surgery for treating non-perforated appendicitis in children, as it did not meet the threshold for non-inferiority

Zooadal used the PHIS database and performed a multi-institutional cohort study of all ARM patients between 2016 and 2022

In ARM patients, rates of associated anomalies were 45.4% vertebral/spinal, 77.4% cardiac, 10.2% TEF, 39.0% renal, and 15.7% limb

25.8% of female ARM patients had a congenital gynecologic malformation diagnosed

The most common anomalies associated with ARMs are cardiac, vertebrospinal, renal, and gynecologic

The authors suggest changing the VACTERL acronym to VACTERL-G to include gynecologic anomalies

The Schlappbach et al. study was a worldwide study with a Delphi consensus process that aimed to update the definitions of sepsis and septic shock

The Phoenix sepsis score includes variables in cardiovascular function, respiratory function, coagulation, and neurological function

The Phoenix sepsis score correlates the definition with an actual mortality rate

Sepsis is defined as suspected infection plus 2 points in the Phoenix sepsis score

Septic shock is defined as sepsis plus cardiovascular dysfunction, seen when there is 1 point in the cardiovascular variable of the Phoenix sepsis score

Sepsis has a mortality rate of 7.1%

Septic shock has a mortality rate of 10.8% to 33.5% according to the research settings