Stress-related mucosal disease in childhood appendicitis

Lansdale, Nick; Hill, R. D.; Hancock, Stephen W.; Thomson, Mike; Marven, Sean

doi:10.1007/s00383-008-2166-0

Cited by 2 publications

(1 citation statement)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We did not have a way to determine if these patients had mucosal disease associated with acute illness as was described in previous studies. 18 Possibly having a complex surgical procedure, more postoperative nausea and vomiting, or simply abdominal discomfort could result in more liberal GI prophylaxis. There might be legitimate reasons for using antacid prophylaxis in patients with more complicated surgeries or those with multiple factors predisposing the patient to stress ulcer development; however, there is no compelling evidence that these are absolute criteria to routinely use antacid therapy.…”

Section: Discussionmentioning

confidence: 99%

Routine Use of Postoperative Acid Suppression (GI Prophylaxis) in Non–Critically Ill Pediatric Appendectomy Patients

Gurevich-Panigrahi

Worley

Hupertz

et al. 2017

Hospital Pediatrics

View full text Add to dashboard Cite

Overutilization of routine gastrointestinal (GI) prophylaxis has been a focus of research for more than a decade in North American and European countries given its potential to increase costs and cause adverse clinical effects. 1,2 Prescription of antacids in inpatient units and their prolonged use cause changes in the intestinal microbiota with consequent increased risk for Clostridium difficile-associated disease 3-5 and nosocomial pneumonia. 1,2,6,7 According to the Choosing Wisely recommendation by the Society of Hospital Medicine, routine GI prophylaxis is not recommended for adults on general medical or surgical floors. 8 The American Society of Health System Pharmacists "Therapeutic Guidelines on Stress Ulcer Prophylaxis" state that patients admitted to the noncritical care hospital setting with ,2 risk factors for bleeding should not receive routine stress ulcer prophylaxis. 9 In pediatric patients, established risk factors for clinically significant stress ulcer-related bleeding and thus potential need for acid suppression include respiratory failure with the need for mechanical ventilation, coagulopathy, a Pediatric Risk of Mortality Score of $10, 10 shock, and thermal injuries. 11,12 There is currently a paucity of formal guidelines on GI prophylaxis outside the ICU in pediatric patients. Whether GI prophylaxis is routinely used in pediatric surgery patients outside the critical care setting without specific evidence based criteria is unknown. Given its potential to cause negative effects and inappropriately high use rates in adults on medical-surgical floors (up to 85%), 13-15 we believe this is an important issue to address in the pediatric population. Therefore, the purpose of this study was to establish the current rate of postoperative GI prophylaxis in pediatric appendectomy patients on regular nursing floors in a single center and factors associated with its use. We hypothesized that a more complicated postoperative course, prolonged nothing-by-mouth status, and concomitant nonsteroidal antiinflammatory drug (NSAID) use might be associated with acid suppression prescriptions. METHODS We conducted a retrospective single-center cohort study at Cleveland Clinic Children' s in Cleveland, Ohio, after gaining approval from the Institutional Review Board. Given that acute appendicitis is the most common diagnosis requiring an urgent general surgical procedure with an associated low risk of bleeding and an expected short

show abstract

Section: Discussionmentioning

confidence: 99%