Nonoperative management in children with early acute appendicitis: A systematic review

Xu, Jane; Adams, Susan; Liu, Yingrui Cyril; Karpelowsky, Jonathan

doi:10.1016/j.jpedsurg.2017.05.003

Cited by 44 publications

(25 citation statements)

References 45 publications

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“…When considering all reports of NOT (comparative and non-comparative), Georgiou et al reported success rates of NOT (defined as discharge home from hospital without appendicectomy during initial hospital admission) in excess of 97% 37. In the most recent systematic review39 reporting NOT for UAA in children, success rate of NOT was 89% or higher in 14 of the 15 included studies but notably only 58% in one report 40. What is less clear, however, due primarily to the absence of well-designed RCTs, is the relative efficacy of NOT when compared with appendicectomy.…”

Section: Non-operative Treatment For Uaa In Childrenmentioning

confidence: 99%

Non-operative management of appendicitis in children

Hall

Eaton

2017

Arch Dis Child

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Whilst appendicectomy has been considered the mainstay of treatment for children with acute appendicitis for many decades there has been a great deal of recent interest in non-operative treatment (NOT) with antibiotics alone. Initial results suggest that many children with appendicitis can indeed be safely treated with NOT and can be spared the surgeon's knife. Many as yet unanswered questions remain however before NOT can be considered a realistic and reliable alternative to the surgery. This review summaries current knowledge and understanding of the role of NOT in children with appendicitis and outlines and discusses the outstanding knowledge gaps.

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Section: Non-operative Treatment For Uaa In Childrenmentioning

confidence: 99%

Non-operative management of appendicitis in children

Hall

Eaton

2017

Arch Dis Child

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“…Answer: a. Non‐operative management (NOM) for uncomplicated appendicitis is now an accepted approach, even if there are a few reports in children, mostly in toddlers. A recent systematic review showed that initial success of the NOM groups (a cure within 2 weeks of intervention) in the paediatric age group is followed by recurrence at 1 year until 31.8% . In this regard, prediction of negative outcome is important in the selection of the NOM: The presence of an appendicolith is correlated to an unacceptably high failure rate in paediatric patients treated with NOM.…”

Section: Multiple Choice Questionsmentioning

confidence: 99%

“…A recent systematic review showed that initial success of the NOM groups (a cure within 2 weeks of intervention) in the paediatric age group is followed by recurrence at 1 year until 31.8%. 8 In this regard, prediction of negative outcome is important in the selection of the NOM: The presence of an appendicolith is correlated to an unacceptably high failure rate in paediatric patients treated with NOM. This is likely owing to a high proportion of these children having more advanced (gangrenous or perforated) appendicitis despite a pre-operative evaluation suggesting uncomplicated acute appendicitis.…”

Section: Multiple Choice Questionsmentioning

confidence: 99%

Still toddler: A clinical clue for acute appendicitis

Cozzi

Galdo

Germani

et al. 2018

J Paediatrics Child Health

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“…Therefore, the necessity of an appendectomy is being challenged and non-operative treatment (NOT) of uncomplicated appendicitis in children is gaining ground. Recently five systematic reviews [13, 15, 19, 21, 42] were published, including 13 studies with a total of 808 children treated non-operatively. The included study designs comprise retrospective studies, prospective cohort studies, and one pilot randomized controlled trial (RCT).…”

Section: Introductionmentioning

confidence: 99%

“…One systematic review deemed NOT inferior because of the risk of recurrent appendicitis and subsequent higher re-admission rates [21]. So far adequately powered RCTs are lacking [13, 15, 21, 42] and data on other important outcomes such as life-impact and costs is scarce. In our experience clinicians have doubts concerning the recovery of patients after NOT, particularly regarding prolonged abdominal pain and gastro-intestinal symptoms.…”

Section: Introductionmentioning

confidence: 99%

Clinical recovery in children with uncomplicated appendicitis undergoing non-operative treatment: secondary analysis of a prospective cohort study

et al. 2018

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Non-operative treatment of uncomplicated appendicitis in children is gaining ground. Pending definitive evidence regarding its effectiveness, there is a call to evaluate clinical recovery after non-operative treatment. In this study, we analyzed data collected during initial admission of a multicenter prospective cohort in which children, 7–17 year, were treated non-operatively for uncomplicated appendicitis. During admission clinical parameters (pain and gastro-intestinal symptoms), inflammation parameters and sequential abdominal ultrasound were recorded. In total, 45 children were included, 42(93%) were discharged without the need for appendectomy; median [IQR] pain scores on admission were 5 [4–7], decreasing to 2 [0–3] after 1 day of treatment. Initially, 28/42 (67%) reported nausea and 19/42 (45%) vomiting; after 1 day, this was 3/42 (7%) and 1/42 (2%), respectively. White blood cell count declined from a median [IQR] of 12.9 [10.7–16.7] 10E9/L on admission to 7.0 [5.8–9.9] 10E9/L on day 1. Median [IQR] C-reactive protein levels increased from 27.5 [9–69] mg/L on admission to 48 [22–80] mg/L on day 1, declining to 21.5 [11–42] mg/L on day 2. Follow-up ultrasound showed no signs of complicated appendicitis in any of the patients.Conclusion: Clinical symptoms resolved in most children after 1 day of non-operative treatment. This suggests that non-operative treatment is a viable alternative to appendectomy regarding clinical recovery.Trail registration: NCT01356641 What is Known: • Non-operative treatment of uncomplicated appendicitis in children is safe and its use around the world is gaining ground, however high quality evidence from adequately designed randomized trials is still lacking.• Concerns have been raised regarding the potentially prolonged clinical recovery associated with non-operative treatment. What is New: • Most clinical symptoms resolve after 1 day of non-operative treatment in the majority of children.Electronic supplementary materialThe online version of this article (10.1007/s00431-018-3277-9) contains supplementary material, which is available to authorized users.

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Nonoperative management in children with early acute appendicitis: A systematic review

Cited by 44 publications

References 45 publications

Non-operative management of appendicitis in children

Non-operative management of appendicitis in children

Still toddler: A clinical clue for acute appendicitis

Clinical recovery in children with uncomplicated appendicitis undergoing non-operative treatment: secondary analysis of a prospective cohort study

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