[Acute appendicitis. Usefulness of a evidence-based critical pathway]

To determine the effects of an evidence-based clinical pathway for acute appendicitis in paediatric patients at a tertiary hospital.

We studied 229 patients with an age range from 3 to 14 years, with a pathological diagnosis of acute appendicitis divided in two groups. A prospective, experimental clinical pathway group of children (n = 114), (June 1999-January 2001) was compared with a historical control prepathway group of patients treated by conventional means in the previous years, (n = 115), (December 1997-May 1999). Age, gender, type of appendicitis (uncomplicated/complicated), length of hospitalisation, number of antibiotics doses supplied and rates of complications, were compared between pathway and and control patients.

There were no differences in age (p = 0.61), gender (p = 0.73), either the number of complicated/uncomplicated appendicitis (p = 0.91) between the two groups. The average duration of hospitalisation was significantly shortened in pathway group (4.34 versus 5.33 days) (p = 0.000049) and the number of antibiotics doses were reduced from 16.13 to 11.17 doses (p = 0.000000). The number of major complications was lower in the pathway group than in the control group (6 and 16 respectively) but there was no significative difference (p = 0.09).

Clinical pathway is an efficient and safe tool for acute appendicitis because decrease the length of hospitalisation and the number of antibiotics doses supplied, while maintaining quality of care.