Age as an Exclusion Criterion for Nonoperative Management in Simple Acute Appendicitis in Children.

IF 1.5 3区 医学 Q2 PEDIATRICS
European Journal of Pediatric Surgery Pub Date : 2024-02-01 Epub Date: 2023-08-17 DOI:10.1055/a-2155-7642
Gal Becker, Audelia Eshel Fuhrer, Keren Kremer, Annabella Hochschild, Haguy Kammar, Igor Sukhotnik
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引用次数: 0

Abstract

Objective:  Nonoperative management (NOM) for simple acute appendicitis (SAA) is an acceptable mode of treatment in healthy children. Previous studies of NOM routinely excluded young children (< 5 years); however, the effect of age on NOM failure has not been directly assessed. Efficiency of NOM in young adults is questionable. Therefore, adolescents may also be at greater risk of NOM failure. Our aim was to investigate the effect of age on NOM failure.

Methods:  This is a retrospective analysis of children with SAA who received NOM between January 1, 2019, and June 30, 2021, at our institution. NOM failure was defined by subsequent appendectomy. Age was assessed as a continuous variable, and we also compared different age subgroups.

Results:  In this study, 151 children were included (60% male), mean age 11.2 ± 3.2 years (range: 5-17). Overall, 66 children (44%) failed NOM, 90% of them within the first year (median 7 weeks). Ten percent of the cohort were younger than 6 years of age and 33% of them failed NOM (p = 0.39). Per 1 year increase in age, the odds of NOM failure increased by 12% (p = 0.027). Children over 14 years of age had 2.46 times higher odds to fail NOM (p = 0.03). These higher odds remained after adjusting for appendiceal diameter and appendicolith. Linear regression showed a decrease by a factor of 12 at the time of NOM failure with every 1-year increase in age (β = -12, p = 0.09).

Conclusion:  The risk of NOM failure in children increases with age; therefore, age should be considered when deciding on the optimal management of SAA, especially in adolescents. Effectiveness of NOM in children younger than 6 years is noninferior to older children and therefore should not be excluded.

年龄作为儿童单纯性急性阑尾炎非手术治疗的排除标准。
目标: 单纯性急性阑尾炎(SAA)的非手术治疗(NOM)是健康儿童可接受的治疗模式。先前的NOM研究通常排除幼儿(<5岁);然而,年龄对NOM失败的影响尚未得到直接评估。NOM在年轻人中的有效性值得怀疑。因此,青少年也可能面临更大的NOM失败风险。我们的目的是研究年龄对NOM失败的影响。方法: 这是对2019年1月1日至2021年6月30日在我们机构接受NOM治疗的SAA儿童的回顾性分析。NOM失败是由随后的阑尾切除术确定的。年龄被评估为一个连续变量,我们还比较了不同的年龄亚组。结果: 在这项研究中,包括151名儿童(60%为男性),平均年龄11.2岁 ± 3.2年(范围:5-17年)。总体而言,66名儿童(44%)未通过NOM,其中90%在第一年内(中位数为7周)。10%的研究对象年龄小于6岁,33%的研究对象未通过NOM(p = 年龄每增加1年,NOM失败的几率增加12%(p = 0.027)。14岁以上儿童NOM失败的几率高出2.46倍(p = 0.03)。在调整阑尾直径和阑尾厚度后,这些较高的几率仍然存在。线性回归显示,在NOM失败时,随着年龄的每增加1年,NOM下降了12倍(β = -12,p = 0.09)。结论: 儿童NOM失败的风险随着年龄的增长而增加;因此,在决定SAA的最佳管理时,应考虑年龄,尤其是在青少年中。NOM在6岁以下儿童中的有效性不劣于年龄较大的儿童,因此不应被排除在外。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
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