More Intense Pain predicts Failure of treatment with antibiotics in kids with Appendicitis: JAMA

The factors associated with the failure of nonoperative management of appendicitis and the differences in patient-reported outcomes between successful and unsuccessful nonoperative management remain unknown.

A study was conducted to investigate factors associated with the failure of nonoperative management of appendicitis and compare patient-reported outcomes between patients whose treatment succeeded and those whose treatment failed.

This study was a planned subgroup secondary analysis conducted in 10 children's hospitals that included 370 children aged 7 to 17 years with uncomplicated appendicitis enrolled in a prospective, nonrandomized clinical trial between May 1, 2015, and October 31, 2018, with 1-year follow-up comparing nonoperative management with antibiotics vs surgery for uncomplicated appendicitis. Statistical analysis was performed from November 1, 2019, to February 12, 2022. Failure of nonoperative management and patient-reported outcomes. The relative risk (RR) of failure based on sociodemographic and clinical characteristics was calculated. Patient-reported outcomes were compared based on the success or failure of nonoperative management.

Results:

• Of 370 patients enrolled in the nonoperative group, treatment failure occurred for 125 patients (33.8%) at 1 year, with 53 patients (14.3%) undergoing appendectomy during initial hospitalization and 72 patients (19.5%) experiencing delayed treatment failure after hospital discharge.
• Higher patient-reported pain at presentation was associated with increased risk of in-hospital treatment failure but not delayed treatment failure or overall treatment failure at 1 year.
• Pain duration greater than 24 hours was associated with decreased risk of delayed treatment failure but not in-hospital treatment failure or treatment failure at 1 year.
• There was no increased risk of treatment failure associated with age, white blood cell count, sex, race, ethnicity, primary language, insurance status, transfer status, symptoms at presentation, or imaging results.
• Health care satisfaction at 30 days and patient-reported, health-related quality of life at 30 days and 1 year were not different. Satisfaction with the decision was higher with successful nonoperative management at 30 days and 1 year

This analysis suggests that a higher pain level at presentation was associated with a higher risk of initial failure of nonoperative management and that a longer duration of pain was associated with lower risk of delayed treatment failure. Although satisfaction was high in both groups, satisfaction with the treatment decision was higher among patients with successful nonoperative management at 1 year.

Reference:

Demographic and Clinical Characteristics Associated With the Failure of Nonoperative Management of Uncomplicated Appendicitis in Children Secondary Analysis of a Nonrandomized Clinical Trial by Peter C. Minneci, et al. published in the JAMA.

doi:10.1001/jamanetworkopen.2022.9712

Keywords:

More, Intense, Pain, predicts, Failure, treatment, antibiotics, kids, Appendicitis, JAMA, Demographic, Clinical Characteristics, Associated, Failure of Nonoperative, Management, Uncomplicated Appendicitis, Peter C. Minneci, Erinn M. Hade, Lindsay A. Gil, Gregory A. Metzger, Jacqueline M. Saito, Grace Z. Mak, Ronald B. Hirschl, Samir Gadepalli, Michael A. Helmrath, Charles M. Leys, Thomas T. Sato, Dave R. Lal,