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.
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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.
| Type: | Article |
|---|---|
| Title: | Efficacy and safety of non-operative treatment for acute appendicitis: a meta-analysis |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1542/peds.2016-3003 |
| Publisher version: | http://dx.doi.org/10.1542/peds.2016-3003 |
| Language: | English |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Biology and Cancer Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1529248 |
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