Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
School of Applied Science, Temasek Polytechnic, 21 Tampines Ave 1, Singapore, 529757, Singapore.
Eur J Pediatr. 2020 May;179(5):735-742. doi: 10.1007/s00431-019-03555-w. Epub 2020 Jan 3.
Studies show that conservative management in acute uncomplicated appendicitis (AUA) is an alternative to surgery. This study aims to determine factors affecting parental preference in management of AUA and their decision for research participation. We conducted surveys on parents whose children were admitted with suspicion of appendicitis but later confirmed not to have appendicitis. Information on appendicectomy versus conservative treatment with antibiotics was provided using a fixed script and standard information leaflet. Questionnaires covered factors influencing decisions, opinions regarding research, treatment preference and demographic data. We excluded parents not fluent in English. Of 113 respondents, 71(62.8%) chose antibiotics, 39(34.5%) chose appendicectomy, and 3(2.7%) had no preference. Reasons given for choosing antibiotics were fear of surgical risks and preferring less invasive treatment. Those choosing appendicectomy expressed preference for definitive treatment and fear of recurrence. Majority were against randomisation (n = 89, 78.8%) and blinding (n = 90, 79.7%). Over half found difficulty involving their child in research (n = 65, 57.5%). Most thought that research is important (66.4%) and beneficial to others (59.3%). Parents who perceived their child as healthy found research riskier (p = 0.039). Educated parents were more likely to find research beneficial to others (p = 0.012) but less accepting of randomisation (p = 0.001).Conclusion: More parents appear to prefer conservative treatment for acute uncomplicated appendicitis. Researchers must consider parental concerns regarding randomisation and blinding.What is Known:• Conservative management of acute uncomplicated appendicitis in paediatric patients is safe and effective, sparing the child the need for an operation; however, neither conservative nor surgical management is proven to be superior.• Randomised controlled trials provide the highest level of evidence, but it is challenging to recruit paediatric patients as participants in such clinical trials.What is New:• More parents prefer conservative management of uncomplicated appendicitis over surgical management for their children due to fear of surgical risks and complications• Randomisation in trial design is significantly associated with a parent's decision to reject their child's participation in a clinical trial.
研究表明，在急性单纯性阑尾炎（AUA）中采用保守治疗是手术治疗的一种替代方法。本研究旨在确定影响父母对 AUA 管理偏好的因素及其参与研究的决策。我们对因疑似阑尾炎而入院但后来证实无阑尾炎的患儿的父母进行了调查。使用固定脚本和标准信息传单提供阑尾切除术与抗生素保守治疗的信息。调查问卷涵盖了影响决策的因素、对研究的看法、治疗偏好和人口统计学数据。我们排除了不精通英语的父母。在 113 名受访者中，71 名（62.8%）选择了抗生素，39 名（34.5%）选择了阑尾切除术，3 名（2.7%）没有偏好。选择抗生素的原因是担心手术风险和更倾向于采用微创治疗。选择阑尾切除术的人表示更倾向于确定性治疗和担心复发。大多数人反对随机化（n=89，78.8%）和盲法（n=90，79.7%）。超过一半的人发现让孩子参与研究有困难（n=65，57.5%）。大多数人认为研究很重要（66.4%），对他人有益（59.3%）。认为孩子健康的父母认为研究风险更高（p=0.039）。受教育程度较高的父母更有可能认为研究对他人有益（p=0.012），但对随机化的接受程度较低（p=0.001）。结论：更多的父母似乎更倾向于对急性单纯性阑尾炎采用保守治疗。研究人员必须考虑父母对随机化和盲法的担忧。已知情况：1. 对儿科患者进行急性单纯性阑尾炎的保守治疗是安全有效的，无需手术；然而，无论是保守治疗还是手术治疗都不能证明更优越。2. 随机对照试验提供了最高水平的证据，但招募儿科患者作为此类临床试验的参与者具有挑战性。新发现：1. 由于担心手术风险和并发症，更多的父母更愿意选择对其子女进行保守治疗而非手术治疗来治疗单纯性阑尾炎。2. 随机试验设计与父母决定拒绝其子女参与临床试验显著相关。
