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Non-Operative Management of Uncomplicated Appendicitis in Children: Can Patients Be Discharged From the Emergency Department?
Froehlich, Mary; Karunungan, Krystal; Jen, Howard C; Wagner, Justin P; Shekherdimian, Shant; Sullins, Veronica F; DeUgarte, Daniel A; Lee, Steven.
Afiliación
  • Froehlich M; Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA.
  • Karunungan K; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
  • Jen HC; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
  • Wagner JP; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
  • Shekherdimian S; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
  • Sullins VF; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
  • DeUgarte DA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
  • Lee S; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; University of Washington School of Medicine, Seattle, WA, USA. Electronic address: steven.lee@seattlechildrens.org.
J Pediatr Surg ; : 161643, 2024 Aug 12.
Article en En | MEDLINE | ID: mdl-39261188
ABSTRACT

INTRODUCTION:

Non-operative management of uncomplicated appendicitis in children is a safe alternative to laparoscopic appendectomy. The purpose of this study is to determine the feasibility of nonoperative outpatient management of uncomplicated appendicitis in pediatric patients.

METHODS:

A standardized pathway for non-operative outpatient management of uncomplicated appendicitis in children (NOMA-C) was implemented in a university pediatric surgery practice starting October 2021. Those who met criteria would be considered for discharge from the emergency department (ED) with oral antibiotics and close followup over the following year. A quality improvement project started concurrently to monitor patients for recurrent symptoms of appendicitis.

RESULTS:

A total of 121 patients were diagnosed with acute appendicitis during the study period (October 2021 to April 2023). Forty-five children (38%) met criteria for the NOMA-C protocol, and 11 patients/families chose appendectomy. Of the 34 patients who pursued nonoperative management, 14 patients were admitted to the hospital and 20 patients were discharged from the ED. Total time in the ED/hospital was significantly shorter for patients discharged from the ED (7 hours versus 23 hours; p<0.001). At one year follow up only 4 (12%) had undergone appendectomy. There were no adverse events for patients who underwent nonoperative management.

CONCLUSION:

A protocol offering non-operative management of appendicitis with an option for outpatient management was feasible and safe. Outpatient management was associated with shorter ED/hospital stays than those admitted. Future studies should evaluate whether this protocol can be adopted by EDs without pediatric surgery services to avoid the need for transfer.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Pediatr Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Pediatr Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos