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Acute appendicitis in children: Reexamining indications for conservative treatment - A large prospective analysis

Zvi Steiner1, Yuval Gilad2, Michael Gutermacher3

  • 1Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Journal of Pediatric Surgery
|January 7, 2022
PubMed

Insights

Conservative antibiotic treatment (CAT) for acute appendicitis (AUA) in children is effective, but older age, larger appendix diameter, and high white blood cell counts increase recurrence risk. A predictive model aids treatment decisions.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Infectious Diseases

Background:

  • Conservative antibiotic treatment (CAT) is a safe option for uncomplicated acute appendicitis (AUA) in children.
  • However, recurrent appendicitis and subsequent appendectomy rates are significant concerns with CAT.

Purpose of the Study:

  • To identify risk factors for recurrent AUA after CAT in a large pediatric cohort.
  • To develop a predictive model for appendectomy probability following CAT.

Main Methods:

  • Prospective longitudinal study of 646 children (ages 5-16) treated with CAT for AUA.
  • Data collected included age, appendix diameter, white blood cell (WBC) count, and C-reactive protein (CRP).
  • Long-term clinical and ultrasonographic follow-up was conducted.

Main Results:

  • Overall CAT success rate was 79%, with 28% readmitted for recurrent AUA and 21% undergoing appendectomy.
  • Older age, larger appendix outer diameter, and higher WBC counts were significant predictors of appendectomy.
  • A decision tree model was developed to predict appendectomy risk.

Conclusions:

  • Older age, larger appendix diameter, and high WBC counts are key risk factors for recurrent AUA and appendectomy after CAT.
  • The developed decision tree model can assist clinicians and parents in treatment planning for AUA.
Abstract

Keywords:
AppendectomyChildrenConservative antibiotic treatmentRecurrent appendicitisTreatment study

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