Featured Research

from universities, journals, and other organizations

Antibiotics Alone Are Successful Treatment for Uncomplicated Acute Appendicitis in Children

Date:
April 14, 2014
Source:
Nationwide Children's Hospital
Summary:
Using antibiotics alone to treat children with uncomplicated acute appendicitis is a reasonable alternative to surgery that leads to less pain and fewer missed school days, according to a pilot study. The research is the first prospective study on nonoperative management of acute appendicitis in pediatric patients in the United States.

Using antibiotics alone to treat children with uncomplicated acute appendicitis is a reasonable alternative to surgery that leads to less pain and fewer missed school days, according to a pilot study. The research, led by a team at Nationwide Children's Hospital and published online April 12 in the Journal of the American College of Surgeons, is the first prospective study on nonoperative management of acute appendicitis in pediatric patients in the United States.

Related Articles


Researchers enrolled 77 patients age 7 to 17 who were diagnosed with uncomplicated acute appendicitis by a surgeon in the Emergency Department at Nationwide Children's between October 2012 and October 2013. Participants had experienced abdominal pain for no more than 48 hours; had a white blood cell count below 18,000; underwent an ultrasound or CT scan to rule out rupture and to verify that their appendix was 1.1 cm thick or smaller; and had no evidence of abscess or fecalith, which is hard stone made of calcified stool.

Thirty patient families chose antibiotics alone and 47 opted for surgery. Those in the non-operative group were admitted to the hospital and received IV antibiotics for at least 24 hours, followed by oral antibiotics for a total of 10 days after discharge. Among those patients, 93 percent showed improvement within 24 hours. Three patients ultimately underwent an appendectomy when the symptoms failed to resolve, but none experienced an appendix rupture.

"Based on the current study, children with uncomplicated appendicitis are good candidates for non-operative management," says Katherine J. Deans, MD, who led the study with Peter C. Minneci, MD. The pair are co-directors of the Center for Surgical Outcomes and principal investigators in the Center for Innovation in Pediatric Practice in The Research Institute at Nationwide Children's.

Appendicitis, caused by a bacterial infection in the appendix, is the most common reason for emergency abdominal surgery in children, sending more than 80,000 young people to the operating room each year. Although many of these cases are severe and require surgery, there are a good number that would be candidates for treatment with antibiotics alone, Dr. Minneci says.

"About 20 percent of the kids with appendicitis who came here had uncomplicated appendicitis, which is would what I would expect to see at any major children's hospital," he says, adding that the results from their study are similar to those from a series of European studies performed in adults that have found that in most cases, appendicitis doesn't require surgery at all.

To study the option further, Drs. Deans and Minneci are coordinating efforts by 10 other pediatric hospitals in the Midwest Pediatric Surgical Consortium to enroll as many 800 children over the next few years in similar trials.

"With our pilot project, we started with the group of patients who would be most likely to have success with an antibiotics-only approach and would be least likely to be harmed, but the next step is to try to slowly add some of the patients who were excluded in the preliminary study to see how well they do," Dr. Minneci says. "It may get to the point that nonoperative management becomes the initial therapy for all appendicitis, but we won't know that until we do further studies."

As with the pilot project, future studies will follow a patient-choice model, meaning participants will not be randomized to one treatment group or the other.

"Patients are more likely to participate in research if they are able to make a choice and not be randomized to one of the two treatment options," Dr. Minneci says. "That is something that's different about this trial."

The notion of involving parents and patients in the decision-making process is under study in a related project led by Drs. Deans and Minneci. Funded by a $1.6 million grant from the Patient-Centered Outcomes Research Institute (PCORI), the researchers are studying the impact of using a novel computer application that engages patients and families as critical decision makers in choosing the therapy that is best for them. The interactive tool offers information about the causes of appendicitis, treatment options and what to expect during and after each kind of treatment. In this study, some participants will receive an iPad with the app to complement their discussions with a surgeon and the others will only talk with the surgeons.

"Through the pilot study, we have learned about the important questions, concerns and values the families have with regard to both operative and nonoperative management of acute appendicitis," Dr. Deans says. "Understanding those concerns prompted us to do the PCORI study, which is really about improving shared decision making with parents and families."


Story Source:

The above story is based on materials provided by Nationwide Children's Hospital. Note: Materials may be edited for content and length.


Journal Reference:

  1. Peter C. Minneci, Jason P. Sulkowski, Kristine M. Nacion, Justin B. Mahida, Jennifer N. Cooper, R. Lawrence Moss, Katherine J. Deans. Feasibility of a Nonoperative Management Strategy for Uncomplicated Acute Appendicitis in Children. Journal of the American College of Surgeons, 2014; DOI: 10.1016/j.jamcollsurg.2014.02.031

Cite This Page:

Nationwide Children's Hospital. "Antibiotics Alone Are Successful Treatment for Uncomplicated Acute Appendicitis in Children." ScienceDaily. ScienceDaily, 14 April 2014. <www.sciencedaily.com/releases/2014/04/140414123509.htm>.
Nationwide Children's Hospital. (2014, April 14). Antibiotics Alone Are Successful Treatment for Uncomplicated Acute Appendicitis in Children. ScienceDaily. Retrieved October 24, 2014 from www.sciencedaily.com/releases/2014/04/140414123509.htm
Nationwide Children's Hospital. "Antibiotics Alone Are Successful Treatment for Uncomplicated Acute Appendicitis in Children." ScienceDaily. www.sciencedaily.com/releases/2014/04/140414123509.htm (accessed October 24, 2014).

Share This



More Health & Medicine News

Friday, October 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Breakfast Debate: To Eat Or Not To Eat?

Breakfast Debate: To Eat Or Not To Eat?

Newsy (Oct. 23, 2014) Conflicting studies published in the same week re-ignited the debate over whether we should be eating breakfast. Video provided by Newsy
Powered by NewsLook.com
Ebola Fears Keep Guinea Hospitals Empty

Ebola Fears Keep Guinea Hospitals Empty

AP (Oct. 23, 2014) Fears of Ebola are keeping doctors and patients alike away from hospitals in the West African nation of Guinea. (Oct. 23) Video provided by AP
Powered by NewsLook.com
Despite Rising Death Toll, Many Survive Ebola

Despite Rising Death Toll, Many Survive Ebola

AP (Oct. 23, 2014) The family of a Dallas nurse infected with Ebola in the US says doctors can no longer detect the virus in her. Despite the mounting death toll in West Africa, there are survivors there too. (Oct. 23) Video provided by AP
Powered by NewsLook.com
Orthodontist Mom Jennifer Salzer on the Best Time for Braces

Orthodontist Mom Jennifer Salzer on the Best Time for Braces

Working Mother (Oct. 22, 2014) Is your child ready? Video provided by Working Mother
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins