Factors influencing choice of medical vs. surgical treatment of pediatric appendicitis

Brahmamdam, Pavan; Carveth, Stephen L.; Smyth, Mary; Gendelman, Brian; Maisels, M. Jeffrey

doi:10.1016/j.jpedsurg.2019.02.053

Cited by 11 publications

(12 citation statements)

References 11 publications

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“…Our study of the existing perspectives of a large cohort of parents/guardians of children has revealed equipoise in their opinions concerning the non‐operative treatment of appendicitis versus immediate surgery. Our acceptance rate of 52% is consistent with previous surveys (37.3% to 62.8%) [15, 21, 22]. However, only one was in a similar outpatient setting [21].…”

Section: Discussionsupporting

confidence: 91%

“…Our acceptance rate of 52% is consistent with previous surveys (37.3% to 62.8%) [15, 21, 22]. However, only one was in a similar outpatient setting [21]. Other surveys included smaller cohorts of approximately 100 respondents and included patients who had been admitted to hospital with either confirmed diagnosis of simple appendicitis or non‐specific abdominal pain.…”

Section: Discussionsupporting

confidence: 86%

“…Differences between individual groups were calculated using Mann-Whitney U test both before and after reading a brief educational content about conservative treatment. For example, parents significantly favoured emergency surgery to antibiotic therapy alone preeducation (p = 0.002) but not post-education (p = 0.05) ES: emergency surgery, AT: antibiotic therapy, IA: interval appendicectomy, Ed: post-education outpatient setting [21]. Other surveys included smaller cohorts of approximately 100 respondents and included patients who had been admitted to hospital with either confirmed diagnosis of simple appendicitis or non-specific abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

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Parental Views on the Non‐Operative Management of Simple Appendicitis in Children: Results of a Cross‐Sectional Survey

et al. 2021

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Background To determine parental attitudes for the non‐operative management of simple appendicitis and determine willingness to participate in research evaluating different management options. Method Voluntary cross‐sectional survey of parents/guardians presenting to paediatric outpatient department. Likert scale of 0–10 (strongly disagree–strongly agree) was utilised, analysis by individual question responses. Results are presented as medians [IQR], paired t test, the Mann–Whitney U test and Kruskal–Wallis test analysis as appropriate. A p value of < 0.05 is considered significant. Results Of 311 respondents, 81% (252/311) completed all the questions. The majority (73%, 220/303) believed that appendicitis needed an urgent operation, and 88% (264/299) believed that perforated appendicitis was a life‐threatening condition. Fifty‐two per cent (131/252) preferred operative management, and 48% (121/252) preferred antibiotic treatment. The most important factors influencing treatment choice were removal of pain (84%, 246/293), removal of infection (83%, 244/293) and minimising complications (54%, 162/293). Concerns regarding antibiotic treatment included the potential for recurrence (75%, 204/271), the risk of progression (63%, 170/271) and the potential of future surgery (53%, 145/271). The perceived beneficial factors of antibiotic treatment included avoiding surgery, 64% (173/269) and surgical complications 68% (184/269). When asked to consider whether they would participate in clinical research evaluating the two treatment options, parents were equally in favour (39%), against (26%) or unsure (35%). Conclusion Our study demonstrates equipoise in the parental acceptance of antibiotics as a treatment simple appendicitis in children, or participation in research evaluating this topic. However, the important factors that may influence this decision have been identified to guide future conversations.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Parental Views on the Non‐Operative Management of Simple Appendicitis in Children: Results of a Cross‐Sectional Survey

et al. 2021

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“…A shared decision, however, should always be in favor. The decision to move forward with conservative management has been controversial regarding complicated appendicitis, and a consensus has yet to be reached [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Conservative Management in Uncomplicated Acute Appendicitis - A Single-Center Retrospective Study

Akbar¹,

Kareem²,

Saleem³

et al. 2022

Cureus

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BackgroundAcute appendicitis remains the most common cause of lower abdominal pain leading to emergency visits. Even though the standard treatment of acute appendicitis remains appendectomy, in recent times, multiple randomized control trials and meta-analyses have deduced conservative treatment as a successful alternative treatment. During the coronavirus disease (COVID) pandemic, with a shortage of staff and resources, treatment with conservative management of uncomplicated acute appendicitis became very beneficial under certain circumstances and conditions. This study aimed to assess whether it is effective to manage patients with uncomplicated acute appendicitis with antibiotic therapy. MethodologyThis was a single hospital based retrospective, cross-sectional study from Jan 2015 to May 2020. Patients with clinical and radiological features of uncomplicated acute appendicitis with Alvarado's score >6 were included in the study. Patients were kept on antibiotics, intravenous fluids, and analgesia as part of a conservative regime. Those who failed to respond to conservative therapy were managed surgically. The follow-up period was six months. ResultsOne hundred eighty-two cases of uncomplicated acute appendicitis were included and managed conservatively, of which 52.2% were males while 47.8% were females. The median age of the patients was 26 years. Conservative treatment was successful in 26.2% of the patients, with a recurrence of 5.5% in the sixmonth follow-up period. The mean number of days of hospital stay was three days in patients treated with conservative or surgical treatment. ConclusionConservative management is gaining popularity, and many centers are inclined towards non-operative management; however, appendectomy remains the gold standard treatment for appendicitis.

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“…Shared decision-making to choose between 2 treatments may be facilitated by a better understanding of how patients and caregivers value the specific risks and benefits of each treatment and how those are associated with their treatment decisions . A recent survey of parents of children who were healthy showed that 42% of caregivers preferred NOM for their child’s appendicitis; however, these families were making only a hypothetical treatment decision, and factors affecting their preferences were not solicited . Our objective in this study was to compare values regarding the risks and benefits of each treatment option between patient-caregiver dyads who chose surgery vs NOM for the child’s appendicitis.…”

mentioning

confidence: 99%

Pediatric Patient and Caregiver Values in Treatment Decision-making for Uncomplicated Appendicitis

et al. 2021

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Factors influencing choice of medical vs. surgical treatment of pediatric appendicitis

Cited by 11 publications

References 11 publications

Parental Views on the Non‐Operative Management of Simple Appendicitis in Children: Results of a Cross‐Sectional Survey

Parental Views on the Non‐Operative Management of Simple Appendicitis in Children: Results of a Cross‐Sectional Survey

The Efficacy of Conservative Management in Uncomplicated Acute Appendicitis - A Single-Center Retrospective Study

Pediatric Patient and Caregiver Values in Treatment Decision-making for Uncomplicated Appendicitis

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