Nav: Home

Families choosing treatment options for uncomplicated appendicitis in children

December 16, 2015

When chosen by the family, nonoperative management with antibiotics alone was an effective treatment strategy for children with uncomplicated appendicitis, incurring less illness and lower costs than surgery, according to a study published online by JAMA Surgery.

Acute appendicitis accounts for approximately 11 percent of pediatric emergency department admissions, with more than 70,000 children hospitalized for it annually in the United States. Although curative, appendectomy is an invasive procedure requiring general anesthesia with associated risks and postoperative pain and disability. Current evidence suggests that nonoperative management of uncomplicated appendicitis is safe, but overall effectiveness is determined by combining medical outcomes with the patient's and family's perspective, goals, and expectations, according to background information in the article.

Peter C. Minneci, M.D., M.H.Sc., and Katherine J. Deans, M.D., M.H.Sc., of the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, and colleagues evaluated the overall effectiveness of nonoperative management for acute uncomplicated pediatric appendicitis, in the context of engaging the family in the treatment decision. The study included 102 patients, 7 to 17 years of age, presenting at a single pediatric acute care hospital. Participating patients and families gave informed consent and chose between urgent appendectomy or nonoperative management entailing at least 24 hours of in-hospital observation while receiving intravenous antibiotics and, on demonstrating improvement of symptoms, completion of 10 days of treatment with antibiotics by mouth.

Sixty-five patients/families chose appendectomy and 37 patients/families chose nonoperative management. The success rate of nonoperative management (defined as not undergoing an appendectomy) was 89 percent at 30 days and 76 percent at 1 year. There was no difference in the rate of complicated appendicitis between those who had undergone appendectomy secondary to failure of nonoperative management and those who chose surgery initially. After 1 year, children managed nonoperatively compared with the surgery group had fewer disability days (8 vs 21 days), lower appendicitis-related health care costs (median, $4,219 vs $5,029), and no difference in health-related quality of life at 1 year.

The authors note that other studies have shown that engaging families in shared decision making in pediatric clinical care has improved medical outcomes.

(JAMA Surgery. Published online December 16, 2015. doi:10.1001/jamasurg.2015.4534. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Should Patients Choose Their Care?

"The idea that patient choice both empowers the patient and improves overall patient satisfaction is well established. The question is, when should patients have the choice?" write Diana Lee Farmer, M.D., F.R.C.S., and Rebecca Anne Stark, M.D., of the University of California Davis School of Medicine, in an accompanying commentary.

"Demonstrating that different treatment options have equivalent outcomes is the first step in determining whether offering a choice is safe. However, balancing the biases of both the physician and the patient is difficult, especially because physician bias is based on personal experience and comfort level and thus may be of more value than the bias of the patient."

"Further study is needed in this arena before we completely abdicate the responsibility for guiding our patient's decision making. Many patients still want us to be 'doctors,' not Google impersonators."

(JAMA Surgery. Published online December 16, 2015. doi:10.1001/jamasurg.2015.4656. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: No conflict of interest disclosures were reported. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
-end-
Media Advisory: To contact Peter C. Minneci, M.D., M.H.Sc., call Gina Bericchia at 614-355-0495 or email MediaRelations@NationwideChildrens.org. To contact commentary co-author Diana Lee Farmer, M.D., F.R.C.S., call Karen Finney at 916-734-9064 or email klfinney@ucdavis.edu.

The JAMA Network Journals

Related Antibiotics Articles:

Antibiotics not necessary for most toothaches, according to new ADA guideline
The American Dental Association (ADA) announced today a new guideline indicating that in most cases, antibiotics are not recommended for toothaches.
Antibiotics with novel mechanism of action discovered
Many life-threatening bacteria are becoming increasingly resistant to existing antibiotics.
Resistance can spread even without the use of antibiotics
Antibiotic resistance does not spread only where and when antibiotics are used in large quantities, ETH researchers conclude from laboratory experiments.
Selective antibiotics following nature's example
Chemists from Konstanz develop selective agents to combat infectious diseases -- based on the structures of natural products
Antibiotics can inhibit skin lymphoma
New research from the LEO Foundation Skin Immunology Research Center at the University of Copenhagen shows, surprisingly, that antibiotics inhibit cancer in the skin in patients with rare type of lymphoma.
Antibiotics may treat endometriosis
Researchers at Washington University School of Medicine in St. Louis have found that treating mice with an antibiotic reduces the size of lesions caused by endometriosis.
How antibiotics help spread resistance
Bacteria can become insensitive to antibiotics by picking up resistance genes from the environment.
Overuse of antibiotics not what the doctor ordered
With increased use of antibiotics worldwide linked to growing antibiotic resistance, a world-first study co-authored by a QUT researcher has highlighted the growing impact of non-prescription supply of antibiotics in community pharmacies, and the urgent need for better enforcement of laws.
Bacterial armor could be a new target for antibiotics
Boosting efforts to fight antibiotic resistance, Stanford researchers have found that a thin membrane, thought to be just a shrink wrap around some bacterial cell walls, has structural properties critical for survival.
Combining antibiotics changes their effectiveness
The effectiveness of antibiotics can be altered by combining them with each other, non-antibiotic drugs or even with food additives.
More Antibiotics News and Antibiotics Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#541 Wayfinding
These days when we want to know where we are or how to get where we want to go, most of us will pull out a smart phone with a built-in GPS and map app. Some of us old timers might still use an old school paper map from time to time. But we didn't always used to lean so heavily on maps and technology, and in some remote places of the world some people still navigate and wayfind their way without the aid of these tools... and in some cases do better without them. This week, host Rachelle Saunders...
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.