Appendicectomy at a children's hospital: what has changed over a decade?

Wilson, Brooke E; Cheney, Lukas; Patel, Bhaveshkumar; Holland, A.J.A.

doi:10.1111/j.1445-2197.2012.06168.x

Cited by 18 publications

(16 citation statements)

References 13 publications

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“…69 Laparoscopy in Australian children increased from <1% in 1999 to 70% in 2009. 70 Although the 2012 data from the National Survey of Research Commercialization in the United Kingdom demonstrated somewhat lower rates of laparoscopy for appendicitis (60%), this population included adults and nontertiary sites, and some centers did not offer laparoscopy after hours or on weekends. 71 A recent Cochrane review, and a pediatric-focused literature review, recommended that the laparoscopic approach be used unless there is a contraindication.…”

Section: Discussionmentioning

confidence: 99%

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

et al. 2015

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Objectives: The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies.Methods: Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with afterhours surgery were determined using generalized estimating equations logistic regression.Results: Of the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p < 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p < 0.001), blood cultures (p < 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p < 0.001 and p = 0.001, respectively), as did the type of surgical approach (p < 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014).Conclusions: Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes.ACADEMIC EMERGENCY MEDICINE 2015;22:811-822 © 2015 by the Society for Academic Emergency Medicine A ppendicitis is the most common nontraumatic surgical emergency in children, 1,2 yet it continues to present diagnostic and management uncertainty.3 Current strategies for diagnosing appendicitis include the use of clinical scoring systems, 4-7 laboratory markers of infection and inflammation, [8][9][10] and

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Section: Discussionmentioning

confidence: 99%

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

et al. 2015

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“…Our results have important implications for managing emergency surgery for children. During the middle of the first decade of this century, children in NSW with non‐complex emergency surgical conditions, such as appendicitis, were often transferred from metropolitan general hospitals to tertiary paediatric hospitals 16 , 17 . In response to this problem, a statewide paediatric surgery framework was proposed in 2008 18 and adopted in 2014 19 .…”

Section: Discussionmentioning

confidence: 99%

“…During the middle of the first decade of this century, children in NSW with non-complex emergency surgical conditions, such as appendicitis, were often transferred from metropolitan general hospitals to tertiary paediatric hospitals. 16,17 In response to this problem, a statewide paediatric surgery framework was proposed in 2008 18 and adopted in 2014. 19 The framework aimed to facilitate the care of children with noncomplex emergency surgical conditions at metropolitan general hospitals, reducing waiting times, delays in appropriate care, and unnecessary travel or hospital transfers for the families of children who required an appendicectomy.…”

Section: Discussionmentioning

confidence: 99%

A population‐based comparison of the post‐operative outcomes of open and laparoscopic appendicectomy in children

Schneuer

Adams

Bentley

et al. 2018

Medical Journal of Australia

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“…These may involve missed diagnosis at birth, delays in follow-up by parents, missed diagnosis or lack of timely referral by general practitioners, or limited availability of hospital resources to conduct surgery. 32,33 Missed diagnosis at birth may have occurred because infants were not examined or UDT was missed owing to a lack of experience or training of maternity care providers. Previous studies reveal that when examination is performed by trained experts, the prevalence of UDT detected at birth is higher, as reported in cohorts from Denmark (9%) 2 and Lithuania (5.4%), 34 compared with the 2.1% reported here.…”

Section: Figurementioning

confidence: 99%