@article{discovery1529248,
            year = {2017},
         journal = {Pediatrics},
       publisher = {American Academy of Pediatrics},
          number = {3},
           month = {February},
           title = {Efficacy and safety of non-operative treatment for acute appendicitis: a meta-analysis},
          volume = {139},
        abstract = {CONTEXT: Non-operative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendicectomy.
OBJECTIVE: To determine safety and efficacy of NOT based on current literature.
DATA SOURCES: Three electronic databases.
STUDY SELECTION: All articles reporting NOT for AUA in children.
DATA EXTRACTION: Two reviewers independently verified study inclusion and extracted data.
RESULTS: Ten articles reporting 413 children receiving NOT were included. Six, including one RCT, compared NOT with appendicectomy. The remaining four reported outcomes of children receiving NOT without a comparison group. NOT was effective as the initial treatment in 97\% of children (95\%CI 96, 99). Initial length of hospital stay was shorter in children treated with appendectomy compared to NOT (mean difference 0.5 days [95\%CI 0.2, 0.8]; p=0.002). At final reported follow-up (range 8 weeks - 4 years), NOT remained effective (no appendicectomy performed) in 79\% of children (95\%CI 73, 86\%). Recurrent appendicitis occurred in 14\% (95\%CI 7, 21). Complications, and total length
of hospital stay during follow-up were similar for NOT and appendicectomy. No serious adverse events related to NOT were reported.
LIMITATIONS: The lack of prospective randomised studies limits definitive conclusions to influence clinical practice.
CONCLUSIONS: Current data suggest that NOT is safe. It appears effective as initial treatment in 97\% of children with AUA and the rate of recurrent appendicitis is 14\%.
Longer term clinical outcomes and cost effectiveness of NOT compared to appendicectomy require further evaluation, preferably as large randomised trials to reliably inform decision making.},
             url = {http://dx.doi.org/10.1542/peds.2016-3003},
            issn = {0031-4005},
          author = {Georgiou, R and Eaton, SJ and Stanton, M and Pierro, A and Hall, N}
}