Department of Pediatric Surgery, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Pediatr Surg. 2021 Feb;31(1):95-101. doi: 10.1055/s-0040-1718406. Epub 2020 Oct 20.
During the past decade, nonoperative management (NOM) for simple acute appendicitis (SAA) in children has been proven safe with noninferior complications rate. The aim of this study was to examine Alvarado score and pediatric appendicitis score (PAS) together with other factors in predicting failure of NOM in children presenting with SAA.
Patients aged 5 to 18 years admitted to our department between 2017 and 2019 diagnosed with SAA were given a choice between surgical management and NOM. We divided the NOM patients into two groups: successful treatment and failed NOM, comparing their files for Alvarado score and PAS and other clinical and demographic factors, with a mean follow-up of 7 months. Failure was determined as need for appendectomy following conservative treatment due to any reason.
A total of 85 patients answered criteria and chose NOM. Overall failure rate was 32.9%. We found no difference in the mean Alvarado score and PAS as well as in each component of both scores between success and failed NOM groups. However, when using the risk classification of the scores, we found a significant correlation between high-risk Alvarado score and failed NOM. After adjusting for age, gender, duration of symptoms, diagnosis of tip appendicitis, and presence of appendicolith, the odds of failure were four times higher among high-risk Alvarado group.
Alvarado score of 7 or higher, older age, and diagnosis of an appendicolith on imaging are possible predictors for failure of NOM for SAA in children.
在过去的十年中，已经证明儿童单纯性急性阑尾炎（SAA）的非手术治疗（NOM）是安全的，且并发症发生率无差异。本研究旨在评估 Alvarado 评分和儿科阑尾炎评分（PAS）以及其他因素在预测 SAA 患儿 NOM 失败中的作用。
2017 年至 2019 年，我们科室收治了 85 名年龄在 5 至 18 岁之间、诊断为 SAA 的患者，他们可以选择手术治疗或 NOM。我们将 NOM 患者分为两组：成功治疗和 NOM 失败，并比较了他们的 Alvarado 评分和 PAS 以及其他临床和人口统计学因素的档案，平均随访 7 个月。失败是指由于任何原因，在保守治疗后需要进行阑尾切除术。
共有 85 名患者符合标准并选择了 NOM。总体失败率为 32.9%。我们发现，成功治疗组和 NOM 失败组之间的平均 Alvarado 评分和 PAS 以及两个评分的每个组成部分均无差异。然而，当使用评分的风险分类时，我们发现高风险 Alvarado 评分与 NOM 失败之间存在显著相关性。在校正年龄、性别、症状持续时间、尖端阑尾炎诊断和阑尾结石存在后，高风险 Alvarado 评分组的 NOM 失败的可能性是高风险 Alvarado 评分组的 4 倍。
Alvarado 评分 7 分或以上、年龄较大和影像学上诊断为阑尾结石是儿童 SAA NOM 失败的可能预测因素。
