Highlights
- •What is currently known about this topic?
- •Pediatric trials have shown that conservative antibiotic treatment for acute uncomplicated appendicitis is a viable option.
- •What new information is contained in this article?
- •Conservative antibiotic treatment in uncomplicated appendicitis in children should consider older age, larger outer appendiceal diameter and high WBC counts as risk-factors for recurrent appendicitis and subsequent appendectomy.
Abstract
Introduction
Conservative antibiotic treatment (CAT) for uncomplicated acute appendicitis (AUA)
in children has been proven safe and efficacious. However, as data accumulate, high
rates of recurrent appendicitis and subsequent appendectomy have been reported. This
prospective longitudinal study evaluated risk-factors for recurrent AUA after CAT
in a large cohort, with long-term follow-up.
Materials and methods
Children ages 5 to 16 years admitted to the Department of Pediatric Surgery from 2014
through 2018, diagnosed with AUA were eligible for CAT. We recorded their age, appendix
outer diameter, white blood cell counts, C-reactive protein and other related signs
and symptoms associated with AUA. Clinical and ultrasonographic follow-up was carried
out until follow-up data collection ceased according to the study design (2014–2019).
Results
The cohort included 646 children who were initially treated successfully with CAT.
Among them, 180 (28%) were readmitted for recurrent acute appendicitis during the
follow-up period and 138 (21%) eventually had appendectomy. Overall success of 79%
for CAT was recorded in this cohort. A multivariable model including; age, sex, appendiceal
diameter, WBC and CRP, found the factors of older age, larger outer appendiceal diameter
and high WBC counts significantly related to appendectomy during the follow-up period.
We offer a decision tree model to predict appendectomy probabilities for patients
based on their prognostic measurements.
Conclusion
CAT in AUA in children should consider older age, larger outer appendiceal diameter
and high WBC counts as risk-factors for recurrent AUA and subsequent appendectomy.
The proposed decision tree model may help both clinicians and parents before CAT is
chosen.
Level of evidence
Level 2
Keywords
Abbreviations:
AUA (uncomplicated acute appendicitis), CAT (Conservative antibiotic treatment), IQR (interquartile range)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 17, 2021
Accepted:
December 7,
2021
Received in revised form:
December 4,
2021
Received:
August 11,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
