Effect of a Clinical Practice Guideline for Pediatric Complicated Appendicitis

Willis, Zachary; Duggan, Eileen; Bucher, Brian T.; Pietsch, John B.; Milovancev, Monica; Wharton, Whitney; Gillon, Jessica; Lovvorn, Harold N.; O’Neill, James A.; Pentima, M. Cecilia Di; Blakely, Martin L.

doi:10.1001/jamasurg.2016.0194

Cited by 87 publications

(76 citation statements)

References 21 publications

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“…Time without fever was one of the most common discharge criteria. The required period without fever ranged between 12 and 72 hours . Only one small underpowered study explicitly excluded a body temperature value from their discharge criteria, with comparable complication rates and LOS reported .…”

Section: Resultsmentioning

confidence: 99%

“…Discharge criteria in application of standardized care pathways for complicated appendicitis in children …”

Section: Resultsmentioning

confidence: 99%

“…A significant reduction in LOS was achieved in eight studies (Table S4). Importantly, in all but one study these outcomes occurred with either comparable or improved rates of complication or readmission .…”

Section: Resultsmentioning

confidence: 99%

“…Standardization of blood test and imaging acquisition was implemented in numerous protocols . Five studies restricted ordering of computed tomography scans to only after the seventh post‐operative day if the child was not meeting discharge criteria, or there was clinical suspicion of an intra‐abdominal abscess .…”

Section: Resultsmentioning

confidence: 99%

“…Deviations from protocols typically resulted from failure of presentation to follow‐up clinic, failure to prescribe the standardized antibiotic course or provision of total parenteral nutrition . Compliance between surgeons was also highly varied between 66.7%–100% indicating ongoing practice variation despite standardization and necessitating uniform surgeon ‘buy‐in’.…”

Section: Discussionmentioning

confidence: 99%

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Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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Background ‘Fast‐track’ surgery protocols aim to standardize and rationalize post‐operative care, with evidence of safety and efficacy in both uncomplicated and complicated childhood appendicitis. Generalization for broader adoption has been limited by variation in protocol design, including specific antibiotic choice, discharge criteria, post‐operative monitoring and patient selection. Methods A systematic review of the literature was performed to evaluate the current evidence underpinning fast‐track protocols for childhood appendicitis and identify areas of consensus and controversy. Results About 33 studies met the inclusion criteria, including four prospective observational studies, 20 case–control studies, seven cohort studies and two randomized controlled trials studying uncomplicated (n = 9), complicated (n = 18) and mixed cohorts (n = 6). Reduction in length of hospital stay was almost universally reported, with equivalent or improved complication rates. Key themes of protocols included antibiotic choice and duration, discharge criteria and post‐operative laboratory and radiographic testing. Rationalized analgesia is an underexplored aspect of protocol design, and a standardized definition of complicated appendicitis remains elusive. Conclusion Standardized care of childhood appendicitis has been shown to be safe and effective in several local and international centres. Next steps include investigation of a complicated appendicitis protocol that integrates rationalized analgesia in appendicectomy recovery, and development of a consistent classification scheme for complicated disease to aid in identification of amenable cohorts.

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Section: Resultsmentioning

confidence: 99%

“…Discharge criteria in application of standardized care pathways for complicated appendicitis in children …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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Gene Expression Profiling in Pediatric Appendicitis

Dhillon,

Kortbeek,

Baghela

et al. 2024

JAMA Pediatr

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ImportanceAppendicitis is the most common indication for urgent surgery in the pediatric population, presenting across a range of severity and with variable complications. Differentiating simple appendicitis (SA) and perforated appendicitis (PA) on presentation may help direct further diagnostic workup and appropriate therapy selection, including antibiotic choice and timing of surgery.ObjectiveTo provide a mechanistic understanding of the differences in disease severity of appendicitis with the objective of developing improved diagnostics and treatments, specifically for the pediatric population.Design, Setting, and ParticipantsThe Gene Expression Profiling of Pediatric Appendicitis (GEPPA) study was a single-center prospective exploratory diagnostic study with transcriptomic profiling of peripheral blood collected from a cohort of children aged 5 to 17 years with abdominal pain and suspected appendicitis between November 2016 and April 2017 at the Alberta Children’s Hospital in Calgary, Alberta, Canada, with data analysis reported in August 2023. There was no patient follow-up in this study.ExposureSA, PA, or nonappendicitis abdominal pain.Main Outcomes and MeasuresBlood transcriptomics was used to develop a hypothesis of underlying mechanistic differences between SA and PA to build mechanistic hypotheses and blood-based diagnostics.ResultsSeventy-one children (mean [SD] age, 11.8 [3.0] years; 48 [67.6%] male) presenting to the emergency department with abdominal pain and suspected appendicitis were investigated using whole-blood transcriptomics. A central role for immune system pathways was revealed in PA, including a dampening of major innate interferon responses. Gene expression changes in patients with PA were consistent with downregulation of immune response and inflammation pathways and shared similarities with gene expression signatures derived from patients with sepsis, including the most severe sepsis endotypes. Despite the challenges in identifying early biomarkers of severe appendicitis, a 4-gene signature that was predictive of PA compared to SA, with an accuracy of 85.7% (95% CI, 72.8-94.1) was identified.ConclusionsThis study found that PA was complicated by a dysregulated immune response. This finding should inform improved diagnostics of severity, early management strategies, and prevention of further postsurgical complications.

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Clinical Practice Guidelines for Pediatric Complicated Appendicitis

Farmer

2016

JAMA Surg

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Effect of a Clinical Practice Guideline for Pediatric Complicated Appendicitis

Cited by 87 publications

References 21 publications

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Gene Expression Profiling in Pediatric Appendicitis

Clinical Practice Guidelines for Pediatric Complicated Appendicitis

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