Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Pediatrics. 2017 Jul;140(1). doi: 10.1542/peds.2017-0048. Epub 2017 Jun 2.
Nonoperative management (NOM) of uncomplicated pediatric appendicitis has promise but remains poorly studied. NOM may lead to an increase in resource utilization. Our objective was to investigate the trends in NOM for uncomplicated appendicitis and study the relevant clinical outcomes including subsequent appendectomy, complications, and resource utilization.
Retrospective analysis of administrative data from 45 US pediatric hospitals. Patients <19 years of age presenting to the emergency department (ED) with appendicitis between 2010 and 2016 were studied. NOM was defined by an ED visit for uncomplicated appendicitis treated with antibiotics and the absence of appendectomy at the index encounter. The main outcomes included trends in NOM among children with uncomplicated appendicitis and frequency of subsequent diagnostic imaging, ED visits, hospitalizations, and appendectomy during 12-month follow-up.
99 001 children with appendicitis were identified, with a median age of 10.9 years. Sixty-six percent were diagnosed with nonperforated appendicitis, of which 4190 (6%) were managed nonoperatively. An increasing number of nonoperative cases were observed over 6 years (absolute difference, +20.4%). During the 12-month follow-up period, NOM patients were more likely to have the following: advanced imaging (+8.9% [95% confidence interval (CI) 7.6% to 10.3%]), ED visits (+11.2% [95% CI 9.3% to 13.2%]), and hospitalizations (+43.7% [95% CI 41.7% to 45.8%]). Among patients managed nonoperatively, 46% had a subsequent appendectomy.
A significant increase in NOM of nonperforated appendicitis was observed over 6 years. Patients with NOM had more subsequent ED visits and hospitalizations compared with those managed operatively at the index visit. A substantial proportion of patients initially managed nonoperatively eventually had an appendectomy.
非手术治疗（NOM）复杂性儿童阑尾炎有一定的前景，但研究仍不完善。NOM 可能会导致资源利用率增加。我们的目的是研究复杂性阑尾炎 NOM 的趋势，并研究相关的临床结果，包括后续的阑尾切除术、并发症和资源利用情况。
对来自 45 家美国儿科医院的行政数据进行回顾性分析。研究对象为 2010 年至 2016 年期间因阑尾炎在急诊科就诊的 19 岁以下患者。NOM 定义为因复杂性阑尾炎在急诊科就诊，接受抗生素治疗，且在就诊时未行阑尾切除术。主要结果包括复杂性阑尾炎患儿中 NOM 的趋势，以及在 12 个月随访期间，后续诊断性影像学检查、急诊科就诊、住院和阑尾切除术的频率。
共纳入 99001 例阑尾炎患儿，中位年龄为 10.9 岁。66%的患儿诊断为非穿孔性阑尾炎，其中 4190 例（6%）接受了非手术治疗。在 6 年期间，接受非手术治疗的病例数量逐渐增加（绝对差异，+20.4%）。在 12 个月的随访期间，NOM 患者更有可能进行以下操作：高级影像学检查（+8.9% [95%置信区间（CI）为 7.6%至 10.3%]）、急诊科就诊（+11.2% [95% CI 为 9.3%至 13.2%]）和住院治疗（+43.7% [95% CI 为 41.7%至 45.8%]）。在接受非手术治疗的患者中，有 46%的患者随后进行了阑尾切除术。
在 6 年期间，非穿孔性阑尾炎的 NOM 显著增加。与首次就诊时接受手术治疗的患者相比，接受 NOM 治疗的患者随后的急诊科就诊和住院治疗更多。最初接受非手术治疗的患者中，相当大比例的患者最终进行了阑尾切除术。
