Contemporary Management of Appendicitis in Children

Rentea, Rebecca M.; Peter, Shawn D. St.

doi:10.1016/j.yapd.2017.03.008

Cited by 26 publications

(38 citation statements)

References 191 publications

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“…A varying proportion of children, but up to 50% in some series46 present with perforated appendicitis. In similarity to uncomplicated appendicitis, the treatment of perforated appendicitis has traditionally been appendicectomy, but it is now recognised that cases of perforated acute appendicitis can also be treated safely and effectively with antibiotics alone or, in cases of intra-abdominal abscess, with antibiotics and percutaneous image-guided abscess drainage.…”

Section: Non-operative Treatment For Perforated Appendicitis In Childrenmentioning

confidence: 99%

Non-operative management of appendicitis in children

Hall

Eaton

2017

Arch Dis Child

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Whilst appendicectomy has been considered the mainstay of treatment for children with acute appendicitis for many decades there has been a great deal of recent interest in non-operative treatment (NOT) with antibiotics alone. Initial results suggest that many children with appendicitis can indeed be safely treated with NOT and can be spared the surgeon's knife. Many as yet unanswered questions remain however before NOT can be considered a realistic and reliable alternative to the surgery. This review summaries current knowledge and understanding of the role of NOT in children with appendicitis and outlines and discusses the outstanding knowledge gaps.

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Section: Non-operative Treatment For Perforated Appendicitis In Childrenmentioning

confidence: 99%

Non-operative management of appendicitis in children

Hall

Eaton

2017

Arch Dis Child

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“…Diagnosis of AA is not always easy [ 1 – 4 ]. Reasons for this are variable symptoms and findings due to progressive inflammatory nature of the pathology, variations of appendix localizations, differences in pain thresholds, and unavailability of standard assessments of both clinicians and radiologists.…”

Section: Discussionmentioning

confidence: 99%

“…The surplus number of scoring systems is an indicator that the ideal system has not yet been found [ 3 , 4 , 29 – 31 ]. In a systematic review for the performance of ASS in predicting appendicitis, authors stated that the heterogeneity was apparent between studies where they have found a nonsignificant trend towards overprediction in the low risk strata and a significant overprediction in the intermediate risk category and high risk strata in children [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Due to its progressive inflammatory pathophysiological course and anatomical variations of the appendix, it may occur in various clinical forms. The decision for surgical exploration is often made upon the clinical course, whereas laboratory and radiological tests are useful in most cases [ 1 – 4 ]. Routine laboratory tests include hemogram, spot urine test, plain X-ray, and ultrasonography.…”

Section: Introductionmentioning

confidence: 99%

“…Routine laboratory tests include hemogram, spot urine test, plain X-ray, and ultrasonography. Computerized tomography may also be used, but its disadvantages of exposure to radiation and high cost make its use debatable [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Retrospective Multivariate Analysis of Data from Children with Suspected Appendicitis: A New Tool for Diagnosis

Dökümcü

Kurtmen

Divarcı

et al. 2018

Emergency Medicine International

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Background Decision-making for management may sometimes be difficult in acute appendicitis (AA). Various diagnostic scoring systems exist, but their sensitivity and specificity rates are far from ideal. In this study, the determination of the predictors and the effect of radiological data and developing a new scoring system were aimed. Methods Medical records of patients who were hospitalized for AA between February 2012 and October 2016 were retrospectively reviewed. All data were compared between patients with and without appendicitis. The multivariate analysis was performed to define significant variables and to examine the sensitivity and specificity of each group of predictors including radiological data. A new scoring system (NSS) was formed and was compared with two existing scoring systems: pediatric appendicitis score (PAS) and Alvarado scoring system (ASS) by using reclassification method. Results Negative appendectomy rate was 11.3%. Statistical analysis identified 21 independently significant variables. The heel drop test had the highest odds ratio. Sensitivity and specificity rates of clinical predictors were 84.6% and 94.8%, respectively. Radiological predictors increased the sensitivity rate to 86.9%. Sensitivity and specificity rates for PAS, ASS, and NSS were 86.8% and 83.9%, 84.7% and 81.6%, and 96.8% and 95.6%, respectively. The “re-assessed negative appendectomy rate” was 6.2% and false positive results were remarkably more common in patients with duration of symptoms less than 24 hours. Conclusion Radiological data improves the accuracy of diagnosis. Containing detailed clinical and radiological data, NSS performs superiorly to PAS and ASS, regarding sensitivity and specificity without any age limitation. The efficiency of NSS may be enhanced by determining different predictors for different phases of the inflammatory process.

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