eprintid: 1529248
rev_number: 37
eprint_status: archive
userid: 608
dir: disk0/01/52/92/48
datestamp: 2016-11-23 15:10:21
lastmod: 2021-12-06 00:58:18
status_changed: 2017-04-05 15:31:52
type: article
metadata_visibility: show
creators_name: Georgiou, R
creators_name: Eaton, SJ
creators_name: Stanton, M
creators_name: Pierro, A
creators_name: Hall, N
title: Efficacy and safety of non-operative treatment for acute appendicitis: a meta-analysis
ispublished: pub
divisions: UCL
divisions: B02
divisions: D13
divisions: G22
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.
date: 2017-02-17
date_type: published
publisher: American Academy of Pediatrics
official_url: http://dx.doi.org/10.1542/peds.2016-3003
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1192453
doi: 10.1542/peds.2016-3003
lyricists_name: Eaton, Simon
lyricists_name: Pierro, Agostino
lyricists_id: SEATO65
lyricists_id: APIER04
actors_name: Eaton, Simon
actors_id: SEATO65
actors_role: owner
full_text_status: public
publication: Pediatrics
volume: 139
number: 3
article_number: e 20163003
issn: 0031-4005
citation:        Georgiou, R;    Eaton, SJ;    Stanton, M;    Pierro, A;    Hall, N;      (2017)    Efficacy and safety of non-operative treatment for acute appendicitis: a meta-analysis.                   Pediatrics , 139  (3)    , Article e 20163003.  10.1542/peds.2016-3003 <https://doi.org/10.1542/peds.2016-3003>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/1529248/1/Manuscript%20Pediatrics%20R1_with_figures.pdf