Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety
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, labora...
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| Veröffentlicht in: | European journal of pediatrics 2017-04, Vol.176 (4), p.521-527 |
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| creator | Steiner, Zvi Buklan, Genady Stackievicz, Rodica Gutermacher, Michael Litmanovitz, Ita Golani, Guy Arnon, Shmuel |
| description | 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.
Conclusion
: 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
. |
| doi_str_mv | 10.1007/s00431-017-2867-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1869963519</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4320827131</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-743c70b536a31e61d81e4a34f17b45f3c72c2f81111de577adfed8be05b0ebc43</originalsourceid><addsrcrecordid>eNp1kE1r3DAQhkVoyG42-QG9BEMvvbjRSLJl5xaWNi0s9NKechCyPC5a1h_RyAv776PNpiEUqoN0mOd9RzyMfQT-BTjXt8S5kpBz0LmoynSdsSUoKXLguvzAllwqnpdQ1wt2SbTlKVNDdcEWohLAK6mW7HE9DoRhb6PfYxYD2tjjEDM_ZPPgxn7aeWcjtpl1c8TMThMOrXc-errLEk2ERC-JscumYF30DjOyHcbDFTvv7I7w-vVdsd_fvv5af883Px9-rO83uZNaxFwr6TRvCllaCVhCWwEqK1UHulFFl4bCia6CdFostLZth23VIC8ajo1TcsU-n3qnMD7NSNH0nhzudnbAcSYDVVnXpSygTuinf9DtOIch_S5RWmuhEpgoOFEujEQBOzMF39twMMDN0bw5mTfJvDmaNyJlbl6b56bH9i3xV3UCxAmgNBr-YHi3-r-tz7CtjzI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1877724963</pqid></control><display><type>article</type><title>Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Steiner, Zvi ; Buklan, Genady ; Stackievicz, Rodica ; Gutermacher, Michael ; Litmanovitz, Ita ; Golani, Guy ; Arnon, Shmuel</creator><creatorcontrib>Steiner, Zvi ; Buklan, Genady ; Stackievicz, Rodica ; Gutermacher, Michael ; Litmanovitz, Ita ; Golani, Guy ; Arnon, Shmuel</creatorcontrib><description>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.
Conclusion
: 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
.</description><identifier>ISSN: 0340-6199</identifier><identifier>EISSN: 1432-1076</identifier><identifier>DOI: 10.1007/s00431-017-2867-2</identifier><identifier>PMID: 28210834</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdomen ; Abscesses ; Acute Disease ; Administration, Intravenous ; Adolescent ; Anti-Bacterial Agents - administration & dosage ; Antibiotics ; Appendectomy ; Appendectomy - statistics & numerical data ; Appendicitis ; Appendicitis - diagnosis ; Appendicitis - drug therapy ; Child ; Conservative Treatment - methods ; Female ; Hospitalization - statistics & numerical data ; Humans ; Length of Stay - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Original Article ; Pediatrics ; Prospective Studies ; ROC Curve ; Statistics, Nonparametric ; Success ; Surgery ; Treatment Outcome ; Ultrasonic imaging ; Ultrasonography ; Vomiting</subject><ispartof>European journal of pediatrics, 2017-04, Vol.176 (4), p.521-527</ispartof><rights>Springer-Verlag Berlin Heidelberg 2017</rights><rights>European Journal of Pediatrics is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-743c70b536a31e61d81e4a34f17b45f3c72c2f81111de577adfed8be05b0ebc43</citedby><cites>FETCH-LOGICAL-c372t-743c70b536a31e61d81e4a34f17b45f3c72c2f81111de577adfed8be05b0ebc43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00431-017-2867-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00431-017-2867-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28210834$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Steiner, Zvi</creatorcontrib><creatorcontrib>Buklan, Genady</creatorcontrib><creatorcontrib>Stackievicz, Rodica</creatorcontrib><creatorcontrib>Gutermacher, Michael</creatorcontrib><creatorcontrib>Litmanovitz, Ita</creatorcontrib><creatorcontrib>Golani, Guy</creatorcontrib><creatorcontrib>Arnon, Shmuel</creatorcontrib><title>Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety</title><title>European journal of pediatrics</title><addtitle>Eur J Pediatr</addtitle><addtitle>Eur J Pediatr</addtitle><description>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.
Conclusion
: 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
.</description><subject>Abdomen</subject><subject>Abscesses</subject><subject>Acute Disease</subject><subject>Administration, Intravenous</subject><subject>Adolescent</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Antibiotics</subject><subject>Appendectomy</subject><subject>Appendectomy - statistics & numerical data</subject><subject>Appendicitis</subject><subject>Appendicitis - diagnosis</subject><subject>Appendicitis - drug therapy</subject><subject>Child</subject><subject>Conservative Treatment - methods</subject><subject>Female</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Pediatrics</subject><subject>Prospective Studies</subject><subject>ROC Curve</subject><subject>Statistics, Nonparametric</subject><subject>Success</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography</subject><subject>Vomiting</subject><issn>0340-6199</issn><issn>1432-1076</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kE1r3DAQhkVoyG42-QG9BEMvvbjRSLJl5xaWNi0s9NKechCyPC5a1h_RyAv776PNpiEUqoN0mOd9RzyMfQT-BTjXt8S5kpBz0LmoynSdsSUoKXLguvzAllwqnpdQ1wt2SbTlKVNDdcEWohLAK6mW7HE9DoRhb6PfYxYD2tjjEDM_ZPPgxn7aeWcjtpl1c8TMThMOrXc-errLEk2ERC-JscumYF30DjOyHcbDFTvv7I7w-vVdsd_fvv5af883Px9-rO83uZNaxFwr6TRvCllaCVhCWwEqK1UHulFFl4bCia6CdFostLZth23VIC8ajo1TcsU-n3qnMD7NSNH0nhzudnbAcSYDVVnXpSygTuinf9DtOIch_S5RWmuhEpgoOFEujEQBOzMF39twMMDN0bw5mTfJvDmaNyJlbl6b56bH9i3xV3UCxAmgNBr-YHi3-r-tz7CtjzI</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Steiner, Zvi</creator><creator>Buklan, Genady</creator><creator>Stackievicz, Rodica</creator><creator>Gutermacher, Michael</creator><creator>Litmanovitz, Ita</creator><creator>Golani, Guy</creator><creator>Arnon, Shmuel</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20170401</creationdate><title>Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety</title><author>Steiner, Zvi ; Buklan, Genady ; Stackievicz, Rodica ; Gutermacher, Michael ; Litmanovitz, Ita ; Golani, Guy ; Arnon, Shmuel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-743c70b536a31e61d81e4a34f17b45f3c72c2f81111de577adfed8be05b0ebc43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdomen</topic><topic>Abscesses</topic><topic>Acute Disease</topic><topic>Administration, Intravenous</topic><topic>Adolescent</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Antibiotics</topic><topic>Appendectomy</topic><topic>Appendectomy - statistics & numerical data</topic><topic>Appendicitis</topic><topic>Appendicitis - diagnosis</topic><topic>Appendicitis - drug therapy</topic><topic>Child</topic><topic>Conservative Treatment - methods</topic><topic>Female</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Pediatrics</topic><topic>Prospective Studies</topic><topic>ROC Curve</topic><topic>Statistics, Nonparametric</topic><topic>Success</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography</topic><topic>Vomiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Steiner, Zvi</creatorcontrib><creatorcontrib>Buklan, Genady</creatorcontrib><creatorcontrib>Stackievicz, Rodica</creatorcontrib><creatorcontrib>Gutermacher, Michael</creatorcontrib><creatorcontrib>Litmanovitz, Ita</creatorcontrib><creatorcontrib>Golani, Guy</creatorcontrib><creatorcontrib>Arnon, Shmuel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Steiner, Zvi</au><au>Buklan, Genady</au><au>Stackievicz, Rodica</au><au>Gutermacher, Michael</au><au>Litmanovitz, Ita</au><au>Golani, Guy</au><au>Arnon, Shmuel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety</atitle><jtitle>European journal of pediatrics</jtitle><stitle>Eur J Pediatr</stitle><addtitle>Eur J Pediatr</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>176</volume><issue>4</issue><spage>521</spage><epage>527</epage><pages>521-527</pages><issn>0340-6199</issn><eissn>1432-1076</eissn><abstract>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.
Conclusion
: 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
.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28210834</pmid><doi>10.1007/s00431-017-2867-2</doi><tpages>7</tpages></addata></record> |
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| language | eng |
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| subjects | Abdomen Abscesses Acute Disease Administration, Intravenous Adolescent Anti-Bacterial Agents - administration & dosage Antibiotics Appendectomy Appendectomy - statistics & numerical data Appendicitis Appendicitis - diagnosis Appendicitis - drug therapy Child Conservative Treatment - methods Female Hospitalization - statistics & numerical data Humans Length of Stay - statistics & numerical data Male Medicine Medicine & Public Health Original Article Pediatrics Prospective Studies ROC Curve Statistics, Nonparametric Success Surgery Treatment Outcome Ultrasonic imaging Ultrasonography Vomiting |
| title | Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety |
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