Medical Professional Publications

What if we could help children with appendicitis avoid surgery?

(From the July/August 2013 issue of Inside Nationwide Children's)

In some cases, delivering the best outcome to a patient and family is providing a new treatment option. A new study here at Nationwide Children’s on the effectiveness of using antibiotics alone to treat early appendicitis in children could allow patients to avoid a surgery many may not need. The $1.6 million project also will explore the impact that involving children and their parents in medical decision-making may have on a child’s response to treatment.

Appendicitis is caused by a bacterial infection in the appendix and sends more than 80,000 children to the operating room each year. In as many as half of those cases, the condition may have been treatable with antibiotics alone, according to Katherine J. Deans, MD, MHSc, and Peter C. Minneci, MD, MHSc, co-directors of the Center for Surgical Outcomes Research at Nationwide Children’s and leaders of this new study, which is funded by the nonprofit Patient-Centered Outcomes Research Institute.

“The idea that surgery is the only treatment for appendicitis goes back to 50 or 60 years ago when high-resolution imaging studies were unavailable for early diagnosis and antibiotics were less effective in treating intra-abdominal infections,” Dr. Deans says. That’s not the case today, thanks to access to ultrasound and CT scans and a wide range of antibiotics, allowing physicians to more accurately diagnose and treat appendicitis early. 

Participants will be recruited through the emergency room and be randomly assigned to one of two groups—both will discuss appendicitis and treatment options with a physician, but one group will also receive an iPad equipped with an interactive educational app offering information about appendicitis and the antibiotic-alone and surgery treatment options.

Participants will then opt for surgery or a course of IV antibiotics alone. Participants in the latter group will be admitted to the hospital for at least 24 to 48 hours, to monitor whether the drugs are working. If their condition hasn’t improved, they will have surgery. Participants will be followed until age 18 to ensure that appendicitis does not recur in the group that chose antibiotic therapy.

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