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Conservative treatment for uncomplicated appendicitis in children: the CONTRACT feasibility study, including
Nigel J Hall1, Frances C Sherratt2, Simon Eaton3
1Faculty of Medicine, University of Southampton, Southampton, UK.
This study explored the feasibility of a trial comparing non-operative treatment with appendicectomy for childhood appendicitis. Results show a future effectiveness trial is feasible with further preparation and optimized recruitment strategies.
Area of Science:
- Pediatric surgery
- Clinical trial methodology
- Health economics
Background:
- Non-operative treatment is effective for uncomplicated acute appendicitis in children.
- Randomised trial data comparing non-operative treatment with appendicectomy are lacking.
Purpose of the Study:
- To assess the feasibility of a multicentre randomised controlled trial.
- To compare clinical and cost-effectiveness of non-operative treatment versus appendicectomy for uncomplicated acute appendicitis in children.
Main Methods:
- Mixed-methods study including a feasibility randomised controlled trial.
- Embedded qualitative and survey studies, health economic feasibility study, and core outcome set development.
- Recruitment of children (4-15 years) with uncomplicated acute appendicitis.
Main Results:
- 50% recruitment rate in the feasibility trial; high adherence to procedures.
- Qualitative work informed optimisation of trial communication, training, and design.
- Core outcome set developed; adequate surgeon interest for an effectiveness trial.
Conclusions:
- A future effectiveness trial is feasible with additional preparation.
- Optimising outcome measures, case identification, and recruitment is recommended.
- Further work needed to distinguish uncomplicated from advanced appendicitis and agree on primary outcomes.
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