Takafumi Mikami1, Ryo Sueyoshi2, Seitaro Kosaka3, Shiho Yoshida4, Go Miyano5, Takanori Ochi5, Hiroyuki Koga5, Tadaharu Okazaki6, Toshihiro Yanai3, Masahiko Urao7, Geoffrey Lane5, Keisuke Jimbo8, Kazuhiro Suzuki9, Ryohei Kuwatsuru9, Toshiaki Shimizu8, Atsuyuki Yamataka5. 1. Department of Pediatric General and Urogenital Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan. t-mikami@juntendo.ac.jp. 2. Department of Pediatric Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. 3. Department of Pediatric Surgery, Ibaraki Children's Hospital, Ibaraki, Japan. 4. Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan. 5. Department of Pediatric General and Urogenital Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan. 6. Department of Pediatric Surgery, Juntendo Urayasu Hospital, Chiba, Japan. 7. Department of Pediatric Surgery, Juntendo Nerima Hospital, Tokyo, Japan. 8. Department of Pediatrics, Juntendo University Hospital, Tokyo, Japan. 9. Department of Radiology, Juntendo University Hospital, Tokyo, Japan.
Abstract
PURPOSE: The incidence of perforation during antibiotic therapy (AT) of children triaged as non-complicated acute appendicitis (NC-Ap) was investigated. METHODS: Abdominal ultrasonography (US) and/or computed tomography (CT) scans from cases of perforation identified at appendectomy for failed AT were reassessed blindly by a panel of board-certified specialists for any evidence of pre-AT morbidity suggestive of perforation. RESULTS: Of 521 cases triaged as NC-Ap, symptoms resolved with AT in 452 cases (86.8%). All 69/521 (13.2%) cases with persistent symptoms had urgent appendectomy, and 12/521 (2.3%) were found to have perforated. Blind reassessment of US and/or CT scans from these cases identified seven with evidence of perforation when they were triaged as NC-Ap. Thus, the actual incidence of perforation during AT for NC-Ap was actually 12-7 = 5/521 (0.95%). CONCLUSIONS: Perforation is generally believed to be a complication of AT, but inappropriate triaging of cases for AT can bias results by artificially inflating the number of perforations, in this study, by more than double. We are the first to assess the unbiased incidence of perforation during AT for NC-Ap, by reassessing pre-AT US and/or CT scans. The incidence of perforation during AT is actually negligible.
PURPOSE: The incidence of perforation during antibiotic therapy (AT) of children triaged as non-complicated acute appendicitis (NC-Ap) was investigated. METHODS: Abdominal ultrasonography (US) and/or computed tomography (CT) scans from cases of perforation identified at appendectomy for failed AT were reassessed blindly by a panel of board-certified specialists for any evidence of pre-AT morbidity suggestive of perforation. RESULTS: Of 521 cases triaged as NC-Ap, symptoms resolved with AT in 452 cases (86.8%). All 69/521 (13.2%) cases with persistent symptoms had urgent appendectomy, and 12/521 (2.3%) were found to have perforated. Blind reassessment of US and/or CT scans from these cases identified seven with evidence of perforation when they were triaged as NC-Ap. Thus, the actual incidence of perforation during AT for NC-Ap was actually 12-7 = 5/521 (0.95%). CONCLUSIONS: Perforation is generally believed to be a complication of AT, but inappropriate triaging of cases for AT can bias results by artificially inflating the number of perforations, in this study, by more than double. We are the first to assess the unbiased incidence of perforation during AT for NC-Ap, by reassessing pre-AT US and/or CT scans. The incidence of perforation during AT is actually negligible.
Authors: Andrew Scott; Steven L Lee; Daniel A DeUgarte; Stephen B Shew; James C Y Dunn; Shant Shekherdimian Journal: Clin Pediatr (Phila) Date: 2017-03-01 Impact factor: 1.168
Authors: Ramon R Gorter; Johanna H van der Lee; Huibert A Cense; C M Frank Kneepkens; Marc H W A Wijnen; Klaas H In 't Hof; Martin Offringa; Hugo A Heij Journal: Surgery Date: 2015-03-16 Impact factor: 3.982
Authors: Jan F Svensson; Barbora Patkova; Markus Almström; Hussein Naji; Nigel J Hall; Simon Eaton; Agostino Pierro; Tomas Wester Journal: Ann Surg Date: 2015-01 Impact factor: 12.969