Samantha P Kadera1, William R Mower2, Anusha Krishnadasan3, David A Talan4. 1. Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California. Electronic address: skadera@mednet.ucla.edu. 2. Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California. 3. Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California. 4. Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California; Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California.
Abstract
BACKGROUND: Appendicitis has long been considered a progressive inflammatory condition best treated by prompt appendectomy. Recently, several trials comparing initial treatment with antibiotics alone to appendectomy suggest that antibiotic therapy may be a safe option in select patients. However, little is known about patients' understanding of appendicitis, prioritized outcomes, and treatment preferences. MATERIALS AND METHODS: We conducted a prospective, observational survey at a Los Angeles County public hospital emergency department. Trained study coordinators recorded the following data on each subject: basic knowledge of appendicitis, past surgical and antibiotic history, and medical illness outcome priorities. Participants were then educated about appendicitis and were told that studies had demonstrated that appendicitis can be treated safely with antibiotics alone. Subjects were then surveyed as to their preference for urgent surgery or antibiotics alone in a hypothetical scenario of acute uncomplicated appendicitis. RESULTS: Of 129 subjects interviewed, 56 (43%) correctly defined appendicitis, and 69 (53%) identified the treatment for appendicitis as surgery. When presented with a hypothetical acute appendicitis scenario, 57% chose antibiotics over surgery. Persons with previous appendectomy and parents of minors more often chose antibiotics alone, 74% and 63%, respectively. Dying was the most frequently cited and highest-ranked concern about medical illness. CONCLUSIONS: Our results demonstrate that, among persons at one US public hospital, understanding of appendicitis is poor. Once presented with background information about appendicitis and being informed that antibiotics can safely treat appendicitis, many people would prefer an antibiotic approach over appendectomy. Death is the most prioritized concern.
BACKGROUND:Appendicitis has long been considered a progressive inflammatory condition best treated by prompt appendectomy. Recently, several trials comparing initial treatment with antibiotics alone to appendectomy suggest that antibiotic therapy may be a safe option in select patients. However, little is known about patients' understanding of appendicitis, prioritized outcomes, and treatment preferences. MATERIALS AND METHODS: We conducted a prospective, observational survey at a Los Angeles County public hospital emergency department. Trained study coordinators recorded the following data on each subject: basic knowledge of appendicitis, past surgical and antibiotic history, and medical illness outcome priorities. Participants were then educated about appendicitis and were told that studies had demonstrated that appendicitis can be treated safely with antibiotics alone. Subjects were then surveyed as to their preference for urgent surgery or antibiotics alone in a hypothetical scenario of acute uncomplicated appendicitis. RESULTS: Of 129 subjects interviewed, 56 (43%) correctly defined appendicitis, and 69 (53%) identified the treatment for appendicitis as surgery. When presented with a hypothetical acute appendicitis scenario, 57% chose antibiotics over surgery. Persons with previous appendectomy and parents of minors more often chose antibiotics alone, 74% and 63%, respectively. Dying was the most frequently cited and highest-ranked concern about medical illness. CONCLUSIONS: Our results demonstrate that, among persons at one US public hospital, understanding of appendicitis is poor. Once presented with background information about appendicitis and being informed that antibiotics can safely treat appendicitis, many people would prefer an antibiotic approach over appendectomy. Death is the most prioritized concern.
Authors: David A Talan; Darin J Saltzman; William R Mower; Anusha Krishnadasan; Cecilia M Jude; Ricky Amii; Daniel A DeUgarte; James X Wu; Kavitha Pathmarajah; Ashkan Morim; Gregory J Moran Journal: Ann Emerg Med Date: 2016-12-11 Impact factor: 5.721
Authors: Tyler J Loftus; Scott C Brakenridge; Chasen A Croft; R Stephen Smith; Philip A Efron; Frederick A Moore; Alicia M Mohr; Janeen R Jordan Journal: J Surg Res Date: 2017-11-13 Impact factor: 2.192
Authors: Tyler J Loftus; Steven L Raymond; George A Sarosi; Chasen A Croft; R Stephen Smith; Philip A Efron; Frederick A Moore; Scott C Brakenridge; Alicia M Mohr; Janeen R Jordan Journal: J Trauma Acute Care Surg Date: 2017-04 Impact factor: 3.313
Authors: N Ensor; K R Qin; M Sivasubramaniam; B Roddis; K Mayakaduwage; M Pacilli; R M Nataraja Journal: World J Surg Date: 2021-09-23 Impact factor: 3.352
Authors: Tyler J Loftus; Camille G Dessaigne; Chasen A Croft; R Stephen Smith; Philip A Efron; Frederick A Moore; Scott C Brakenridge; Alicia M Mohr; Janeen R Jordan Journal: J Trauma Acute Care Surg Date: 2018-02 Impact factor: 3.313