TY  - JOUR
JF  - Pediatrics
A1  - Georgiou, R
A1  - Eaton, SJ
A1  - Stanton, M
A1  - Pierro, A
A1  - Hall, N
N2  - 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.
ID  - discovery1529248
UR  - http://dx.doi.org/10.1542/peds.2016-3003
PB  - American Academy of Pediatrics
SN  - 0031-4005
IS  - 3
TI  - Efficacy and safety of non-operative treatment for acute appendicitis: a meta-analysis
VL  - 139
AV  - public
Y1  - 2017/02/17/
ER  -