It's time to deconstruct treatment-failure: A randomized controlled trial of nonoperative management of uncomplicated pediatric appendicitis with antibiotics alone

Otero, Sofia Perez; Metzger, Julia W.; Choi, Beatrix Hyemin; Ramaraj, Akila B.; Tashiro, Jun; Kuenzler, Keith A.; Ginsburg, Howard B.; Tomita, Sandra; Fisher, Jason C.

doi:10.1016/j.jpedsurg.2021.09.024

Cited by 16 publications

(12 citation statements)

References 29 publications

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“…The outcome of interest was reported by all seven included studies [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. The serum sodium levels were compared between 1615 and 2808 children belonging to groups A and B, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Children tend to have significantly higher rates of perforation compared with adults, especially those under 5 years of age [ 3 , 26 , 27 , 28 , 29 ]. The standard of treatment in the majority of the centers worldwide is still laparoscopic appendectomy, although recently non-complicated forms of acute appendicitis are more frequently managed with a non-operative approach [ 8 , 9 , 27 , 30 , 31 , 32 ]. Postponed diagnosis and treatment often increase the risk of other complications, such as abscess formation, peritonitis and partial bowel obstruction [ 27 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Appendectomy has long been considered the standard of care for acute appendicitis, but recent studies have demonstrated the effectiveness of conservative management of uncomplicated appendicitis [ 8 ]. Management of complicated appendix requires urgent intervention and intravenous broad-spectrum antibiotics, and complications include abscess formation and diffuse peritonitis.…”

Section: Introductionmentioning

confidence: 99%

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Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

et al. 2022

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Background: Acute appendicitis in the pediatric population remains a diagnostic challenge for clinicians. Despite many biochemical markers, imaging modalities and scoring systems, initial misdiagnosis and complication rates are high in children. This suggests the need for investigations directed towards new diagnostic tools to aid in the diagnosis. Recent studies have shown a correlation between serum sodium levels and complicated appendicitis. Although the exact reasons for hyponatremia in patients with complicated appendicitis are not known, there is persuasive data to support the role of pro-inflammatory cytokines such as IL-6 in the non-osmotic release of antidiuretic hormone. This meta-analysis aims to investigate all available data on hyponatremia as a diagnostic marker of complicated appendicitis in the pediatric population. Methods: The literature search was conducted by two independent investigators according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The scientific databases (PubMed, EMBASE, Web of Science, and Scopus) were systematically searched for relevant studies using the keywords (hyponatremia) AND (appendicitis) AND (children). The methodological quality was assessed using a validated scale, and RevMan 5.4 software was utilized for pooled analysis. Results: Seven studies were included in the final meta-analysis, five of which were retrospective. A total of 1615 and 2808 cases were distributed into two groups: group A with complicated appendicitis and group B with uncomplicated acute appendicitis, respectively. The studies compared serum sodium levels of patients among the groups. Pooling the data demonstrated significantly lower serum sodium levels in children with complicated appendicitis vs. the non-complicated appendicitis (WMD: −3.29, 95% CI = −4.52 to −2.07, p < 0.00001). The estimated heterogeneity among the included studies was substantial and statistically significant (I2 = 98%, p < 0.00001). Conclusion: The results of the present meta-analysis indicate that hyponatremia has potential to be utilized as a biochemical marker in the diagnosis of complicated appendicitis in the pediatric population. However, well designed prospective diagnostic efficiency studies are essential to consolidate the association between hyponatremia and complicated acute appendicitis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

et al. 2022

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“…The usage rates of CT imaging for the diagnosis of acute appendicitis vary according to clinical practice, surgeon preference, and institutions. The average rate is reported as 30-40% [ 24 - 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective analysis reported that the antibiotic treatment was first applied in the emergency department and was provided to be used at home for two or three days in the total course [ 26 ]. The same analyses have reported that the success rate of their treatment was 58-99%.…”

Section: Discussionmentioning

confidence: 99%