Gangrenous appendicitis: No longer complicated

Nordin, Andrew B.; Diefenbach, Karen A.; Sales, Stephen; Christensen, Jeff; Besner, Gail E.; Kenney, Brian D.

doi:10.1016/j.jpedsurg.2018.10.064

Cited by 35 publications

(36 citation statements)

References 12 publications

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“…We made this change because no child with suppurative or gangrenous appendicitis in either cohort developed a postoperative abscess and because other authors have done this without increasing postoperative abscesses. 12 We no longer use WBC counts to determine antibiotic duration because doing so did not significantly reduce antibiotic utilization and may have contributed to delays in discharge. We are in the process of prospectively collecting data on patients treated with this revised protocol to determine its effect on the same outcome measures reported here.…”

Section: Discussionmentioning

confidence: 99%

A Standardized Protocol for the Management of Appendicitis in Children Reduces Resource Utilization

Pennell

Meckmongkol

Arthur

et al. 2020

Pediatric Quality &Amp; Safety

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Introduction: Appendicitis is the most common condition requiring emergency surgery in children. We implemented a standardized protocol (SP) for treating children with appendicitis to provide more uniform care and reduce resource utilization. Methods: All patients younger than 21 years were managed with the SP beginning in January 2017. We compared data from 22 months before and after implementation. The primary outcomes included the length of stay (LOS), antibiotic days, discharge on intravenous antibiotics, utilization of peripherally inserted central catheters lines, and postoperative imaging. Secondary outcomes were protocol adherence and the rates adverse events, including postoperative abscess, return to emergency department or operating room, surgical site infection, and readmission. Results: Protocol adherence was 92.3%. For uncomplicated cases (n = 412), LOS ( P = 0.010) and postoperative antibiotic days ( P < 0.001) were significantly reduced. There was no difference in the rates of any adverse event (6.7% versus 2.7%; P = 0.058), postoperative abscess (0.4% versus 0.0%; P = 0.544), return to emergency department (6.3% versus 2.7%; P = 0.084), readmission (1.8% versus 0.5%; P = 0.245), or postoperative ultrasound (0.4% versus 0.5%; P = 0.705) and computed tomography (0.0% versus 0.5%; P = 0.456). For complicated cases (n = 229), the post-SP cohort had a shorter LOS ( P = 0.015), fewer peripherally inserted central catheters lines (26.9% versus 2.7%; P < 0.001), fewer postoperative ultrasounds (8.4% versus 1.8%; P = 0.027), and fewer discharges on intravenous antibiotics (17.6% versus 0.9%; P < 0.001). There were no differences in adverse events before and after the SP (16.0% versus 18.3%; P = 0.633). Conclusion: Implementing an SP for appendicitis in children reduced resource utilization, and by inference healthcare costs, for both uncomplicated and complicated cases without adversely affecting clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

A Standardized Protocol for the Management of Appendicitis in Children Reduces Resource Utilization

Pennell

Meckmongkol

Arthur

et al. 2020

Pediatric Quality &Amp; Safety

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“…There is need for accurate diagnosis and surgery due to generalized peritonitis and sepsis. Recently appear reports for conservative treatment of level evidence II [32]. It's more often observed in pediatric population and represents a percentage of 12-13% in pathology reports.…”

Section: Are There Special Categories Of Patients With Acute Appendicmentioning

confidence: 99%

Acute Appendicitis: After Correct Diagnosis Conservative Treatment or Surgery?

Charalampopoulos¹,

Koliakos²,

Bagias³

et al. 2022

Doubts, Problems and Certainties About Acute Appendicitis

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Acute appendicitis is the most common surgical disease presented in ED. Ongoing evidence in the literature, in the last 20 years, shows a lot of benefits in favor of conservative treatment. Despite that conservative treatment does not gain the correct position at the daily practice up to day. A large number of parameters related to acute appendicitis, present diversity in their appearance, so the final estimation of the disease may by unclear and the decision for treatment may be incorrect. We analyze these parameters, aiming to clarify their role in correct diagnosis and decision making on appropriate treatment. In the present study a review of the literature is performed, regarding the etiology, pathology, clinical presentation, laboratory, and imaging data of acute appendicitis. The collection and correct estimation of these parameters, is the key for the correct diagnosis of acute appendicitis. Complicated or uncomplicated cases should be diagnosed preoperatively. The next step is the appropriate treatment, conservative or by surgery. At the present time, excluding generalized peritonitis and sepsis, the majority of patients with uncomplicated acute appendicitis and selected complicated cases can by treated successfully by conservative treatment. The majority of patients do not benefit from appendectomy.

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“…A concern of some academics is when the cecal appendix is perforated. According to a study published by the National Institute of Pediatrics of Mexico, micro-perforations can be observed even in the earliest stage of the disease, so that for each stage we add the perforated phase at the margin if it is minimally or grotesquely broken or destroyed (Figures 3 and 4) [11].…”

Section: Classification Of Appendicitismentioning

confidence: 99%

“…According to the findings found during surgery, appendicitis is initially staged as simple or uncomplicated and complicated; this staging sets the course for postoperative treatment. Simple and gangrenous appendicitises are considered uncomplicated and have a good prognosis; perforated and abscessed appendicitises are classified as complicated (Table 2) [11].…”

Section: Classification Of Appendicitismentioning

confidence: 99%

Appendicitis in Children: Fundamentals and Particularities

Castillejos¹,

Herrera²,

Durán³

et al. 2022

Doubts, Problems and Certainties About Acute Appendicitis

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Acute appendicitis in children under 5 years of age is a diagnostic challenge, its delay is usually dramatic and leaves serious sequelae. It is one of the main causes of surgical intervention, it is common for other diseases to be associated with it and to simulate it. Acute appendicitis is of obstructive etiology and its pathophysiology, the bacteriology involved and the evolution of the disease progresses through its phases, from the simple to the complex, is addressed in each case. The typical abdominal pain of appendicitis, in addition to vomiting and fever at a young age, is most often accompanied by an atypical clinical picture such as diarrhea. Integrating the clinical signs at this age requires the full capacity and good sense of the pediatric surgeon. For a correct and timely diagnosis, unfortunately many pediatric patients present in complicated stages of the disease, which implies decision-making regarding the type of surgical intervention and subsequent treatments.

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Gangrenous appendicitis: No longer complicated

Cited by 35 publications

References 12 publications

A Standardized Protocol for the Management of Appendicitis in Children Reduces Resource Utilization

A Standardized Protocol for the Management of Appendicitis in Children Reduces Resource Utilization

Acute Appendicitis: After Correct Diagnosis Conservative Treatment or Surgery?

Appendicitis in Children: Fundamentals and Particularities

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