Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety
| Autor: | Shmuel Arnon, Guy Golani, Michael Gutermacher, Zvi Steiner, Genady Buklan, Ita Litmanovitz, Rodica Stackievicz |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.drug_class Nausea Antibiotics Conservative Treatment Treatment failure Statistics Nonparametric 03 medical and health sciences 0302 clinical medicine medicine Appendectomy Humans Uncomplicated appendicitis Prospective Studies Child Ultrasonography business.industry Length of Stay Appendicitis Surgery Anti-Bacterial Agents Conservative treatment Hospitalization Treatment Outcome ROC Curve 030220 oncology & carcinogenesis Intravenous antibiotics Pediatrics Perinatology and Child Health Acute appendicitis Acute Disease Vomiting 030211 gastroenterology & hepatology Administration Intravenous Female medicine.symptom business |
| Zdroj: | European journal of pediatrics. 176(4) |
| ISSN: | 1432-1076 |
| Popis: | The success rate of conservative treatment for children with uncomplicated appendicitis was prospectively evaluated among 197 children. All who received intravenous antibiotics for 3-5 days, and if symptoms resolved, were discharged home on oral antibiotics for 5 days. Failure rate, symptoms, laboratory signs, and sonographic findings were evaluated for prognostic markers of treatment failure. Children were followed for 18 months. The success rate of conservative treatment was 87%, with shorter hospital stays compared to children who eventually needed surgery (72 [60-84] vs. 84 h [72-126], P = 0.001). Vomiting and/or nausea and intraluminal fluid on sonography were the only prognostic signs of failed treatment (P = 0.028 and P = 0.0001, respectively). After multi-regression analysis, intraluminal fluid was the only prognostic sign for failed treatment (odds ratio = 10.2; 95% CI 3.3-31.8, P = 0.001). Patients who failed conservative treatment were successfully operated without significant morbidity. Pathology findings were compatible with acute or subacute inflammation in 94% of operated AA, with no perforated appendices.When applying rigorous criteria for children with uncomplicated appendicitis, a high success rate can be achieved with conservative treatment. Those who fail conservative treatment have a benign medical course without serious complications. Intraluminal fluid may increase risk for conservative treatment failure. What is Known: • Conservative treatment in uncomplicated acute appendicitis is a reasonable alternative to appendectomy. What is New: • Using rigorous criteria for conservative treatment in uncomplicated acute appendicitis is safe and feasible. • Intraluminal fluid should be considered a contraindication to conservative treatment. |
| Databáze: | OpenAIRE |
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