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Advances in the Diagnosis and Management of Appendicitis in Children

      Appendicitis is the most common surgical emergency in childhood and is associated with the greatest relative burden of hospital cost and surgical site infections within pediatric surgery.

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      References

        • Cameron D.B.
        • Graham D.A.
        • Milliren C.E.
        • et al.
        Quantifying the burden of interhospital cost variation in pediatric surgery: implications for the prioritization of comparative effectiveness research.
        JAMA Pediatr. 2017; 171: e163926
        • Cameron D.B.
        • Serres S.K.
        • Glass C.C.
        • et al.
        Leveraging the incidence, burden, and fiscal implications of unplanned hospital revisits for the prioritization of prevention efforts in pediatric surgery.
        Ann Surg. 2020; 271: 191-199
        • Kronman M.P.
        • Hersh A.L.
        • Gerber J.S.
        • et al.
        Identifying antimicrobial stewardship targets for pediatric surgical patients.
        J Pediatr Infect Dis Soc. 2015; 4: e100-e108
        • Feng C.
        • Anandalwar S.
        • Sidhwa F.
        • et al.
        Beyond perforation: Influence of peritoneal contamination on clinical severity and resource utilization in children with perforated appendicitis.
        J Pediatr Surg. 2016; 51: 1896-1899
        • Yousef Y.
        • Youssef F.
        • Dinh T.
        • et al.
        Risk stratification in pediatric perforated appendicitis: Prospective correlation with outcomes and resource utilization.
        J Pediatr Surg. 2018; 53: 250-255
        • St Peter S.D.
        • Sharp S.W.
        • Holcomb G.W.
        • et al.
        An evidence-based definition for perforated appendicitis derived from a prospective randomized trial.
        J Pediatr Surg. 2008; 43: 2242-2245
      1. American College of Surgeons National Surgical Quality Improvement Program – Pediatric Operations Manual: Appendectomy Procedure Targeted Variables. American College of Surgeons; Chicago (IL): Published online January 2020.

        • Cameron D.B.
        • Anandalwar S.P.
        • Graham D.A.
        • et al.
        Development and implications of an evidence-based and public health-relevant definition of complicated appendicitis in children.
        Ann Surg. 2020; 271: 962-968
        • Anandalwar S.P.
        • Cameron D.B.
        • Graham D.A.
        • et al.
        Association of intraoperative findings with outcomes and resource use in children with complicated appendicitis.
        JAMA Surg. 2018; 153: 1021-1027
        • Benabbas R.
        • Hanna M.
        • Shah J.
        • et al.
        Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis.
        Acad Emerg Med. 2017; 24: 523-551
        • Glass C.C.
        • Rangel S.J.
        Overview and diagnosis of acute appendicitis in children.
        Semin Pediatr Surg. 2016; 25: 198-203
        • American College of Surgeons National Surgical Quality Improvement Program - Pediatrics
        Semiannual Report (NSQIP-P SAR). Dates of surgery Jan 1, 2019 - Dec 31, 2019.
        American College of Surgeons, 2020
      2. AAP SOSu – Avoid CT scan as first-line imaging in suspected appendicitis | Choosing Wisely.
        (Accessed January 3, 2021)
        • Kulik D.M.
        • Uleryk E.M.
        • Maguire J.L.
        Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain.
        J Clin Epidemiol. 2013; 66: 95-104
        • Nielsen J.W.
        • Boomer L.
        • Kurtovic K.
        • et al.
        Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template.
        J Pediatr Surg. 2015; 50: 144-148
        • Nordin A.B.
        • Sales S.
        • Nielsen J.W.
        • et al.
        Standardized ultrasound templates for diagnosing appendicitis reduce annual imaging costs.
        J Surg Res. 2018; 221: 77-83
        • Schuh S.
        • Chan K.
        • Langer J.C.
        • et al.
        Properties of serial ultrasound clinical diagnostic pathway in suspected appendicitis and related computed tomography use.
        Acad Emerg Med. 2015; 22: 406-414
        • Reddan T.
        • Corness J.
        • Harden F.
        • et al.
        Improving the value of ultrasound in children with suspected appendicitis: a prospective study integrating secondary sonographic signs.
        Ultrasonography. 2019; 38: 67-75
        • Anandalwar S.P.
        • Callahan M.J.
        • Bachur R.G.
        • et al.
        Use of white blood cell count and polymorphonuclear leukocyte differential to improve the predictive value of ultrasound for suspected appendicitis in children.
        J Am Coll Surgeons. 2015; 220: 1010-1017
        • Bachur R.G.
        • Callahan M.J.
        • Monuteaux M.C.
        • et al.
        Integration of ultrasound findings and a clinical score in the diagnostic evaluation of pediatric appendicitis.
        J Pediatr. 2015; 166: 1134-1139
        • Kashtan M.
        • Graham D.
        • Anandalwar S.
        • et al.
        Influence of symptom duration and WBC profile on the negative predictive value of a nondiagnostic ultrasound in children with suspected appendicitis.
        J Pediatr Surg. 2020; 55: 1032-1036
        • Schoel L.
        • Maizlin II,
        • Koppelmann T.
        • et al.
        Improving imaging strategies in pediatric appendicitis: a quality improvement initiative.
        J Surg Res. 2018; 230: 131-136
        • Anandalwar S.P.
        • Graham D.A.
        • Kashtan M.A.
        • et al.
        Leveraging the combined predictive value of ultrasound and laboratory data to reduce radiation exposure and resource utilization in children with suspected appendicitis.
        J Surg Res. 2020; 257: 529-536
        • Serres S.K.
        • Cameron D.B.
        • Glass C.C.
        • et al.
        Time to appendectomy and risk of complicated appendicitis and adverse outcomes in children.
        JAMA Pediatr. 2017; 171: 740-746
        • Kovler M.L.
        • Pedroso F.E.
        • Etchill E.W.
        • et al.
        Prolonged in-hospital time to appendectomy is associated with increased complicated appendicitis in children.
        Ann Surg. 2020; (Publish Ahead of Print)https://doi.org/10.1097/SLA.0000000000004316
        • Serres S.K.
        • Graham D.A.
        • Glass C.C.
        • et al.
        Influence of time to appendectomy and operative duration on hospital cost in children with uncomplicated appendicitis.
        J Am Coll Surg. 2018; 226: 1014-1021
        • Jaschinski T.
        • Mosch C.G.
        • Eikermann M.
        • et al.
        Laparoscopic versus open surgery for suspected appendicitis.
        Cochrane Database Syst Rev. 2018; 11https://doi.org/10.1002/14651858.CD001546.pub4
        • St Peter S.D.
        • Adibe O.O.
        • Juang D.
        • et al.
        Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial.
        Ann Surg. 2011; 254: 586-590
        • Gasior A.C.
        • Knott E.M.
        • Holcomb G.W.
        • et al.
        Patient and parental scar assessment after single incision versus standard 3-port laparoscopic appendectomy: long-term follow-up from a prospective randomized trial.
        J Pediatr Surg. 2014; 49 (discussion 122): 120-122
        • Vaos G.
        • Dimopoulou A.
        • Gkioka E.
        • et al.
        Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis.
        J Pediatr Surg. 2019; 54: 1365-1371
        • St Peter S.D.
        • Adibe O.O.
        • Iqbal C.W.
        • et al.
        Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial.
        Ann Surg. 2012; 256: 581-585
        • Anderson K.T.
        • Putnam L.R.
        • Bartz-Kurycki M.A.
        • et al.
        Povidone-iodine irrigation for pediatric perforated appendicitis may be protective: a bayesian pilot randomized controlled trial.
        Ann Surg. 2020; 271: 827-833
        • Fujishiro J.
        • Fujiogi M.
        • Hirahara N.
        • et al.
        Abdominal drainage at appendectomy for complicated appendicitis in children: a propensity-matched comparative study.
        Ann Surg. 2020; (Publish Ahead of Print)https://doi.org/10.1097/SLA.0000000000003804
        • Cameron D.B.
        • Melvin P.
        • Graham D.A.
        • et al.
        Extended versus narrow-spectrum antibiotics in the management of uncomplicated appendicitis in children: a propensity-matched comparative effectiveness study.
        Ann Surg. 2018; 268: 186-192
        • Kashtan M.A.
        • Graham D.A.
        • Melvin P.
        • et al.
        Ceftriaxone combined with metronidazole is superior to cefoxitin alone in the management of uncomplicated appendicitis in children: results from a multicenter collaborative comparative effectiveness study.
        Ann Surg. 2020; https://doi.org/10.1097/SLA.0000000000003704
        • Litz C.N.
        • Asuncion J.B.
        • Danielson P.D.
        • et al.
        Timing of antimicrobial prophylaxis and infectious complications in pediatric patients undergoing appendectomy.
        J Pediatr Surg. 2018; 53: 449-451
        • Andersen B.R.
        • Kallehave F.L.
        • Andersen H.K.
        Antibiotics versus placebo for prevention of postoperative infection after appendicectomy.
        Cochrane Database Syst Rev. 2005; 3 (CD001439)
        • Anandalwar S.P.
        • Rangel S.J.
        What’s in your CPG: analysis of practice variation to prioritize comparative effectiveness Research in the postoperative management of complicated appendicitis [oral abstract].
        in: Presented at the: Annual American College of Surgeons Quality & Safety Conference. 2019 (Washington, DC)
        • Anandalwar S.
        • Graham D.
        • Kashtan M.
        • et al.
        Influence of oral antibiotics following discharge on organ space infections in children with complicated appendicitis.
        Ann Surg. 2019; (Publish Ahead of Print)https://doi.org/10.1097/SLA.0000000000003441
        • Kashtan M.A.
        • Graham D.A.
        • Rangel S.J.
        Utilization and performance benchmarking for postoperative imaging in children with complicated appendicitis: results from a multicenter collaborative cohort study.
        Ann Surg. 2020; https://doi.org/10.1097/SLA.0000000000004250
        • Baumann L.M.
        • Williams K.
        • Oyetunji T.A.
        • et al.
        Optimal timing of postoperative imaging for complicated appendicitis.
        J Laparoendosc Adv Surg Tech A. 2018; 28: 1248-1252
        • Hogan M.J.
        • Marshalleck F.E.
        • Sidhu M.K.
        • et al.
        Quality improvement guidelines for pediatric abscess and fluid drainage.
        J Vasc Interv Radiol. 2012; 23: 1397-1402
        • Kashtan M.A.
        • Rangel S.J.
        Variability, cost, and outcomes associated with the use of parenteral nutrition in children with complicated appendicitis [oral abstract].
        in: Presented at the: 50th Annual American Pediatric Surgical Association Meeting. 2014 (Boston, MA)
        • van Amstel P.
        • Sluckin T.C.
        • van Amstel T.
        • et al.
        Management of appendiceal mass and abscess in children; early appendectomy or initial non-operative treatment? A systematic review and meta-analysis.
        Surg Endosc. 2020; 34: 5234-5249
        • Puapong D.
        • Lee S.L.
        • Haigh P.I.
        • et al.
        Routine interval appendectomy in children is not indicated.
        J Pediatr Surg. 2007; 42: 1500-1503
        • Hall N.J.
        • Jones C.E.
        • Eaton S.
        • et al.
        Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review.
        J Pediatr Surg. 2011; 46: 767-771
        • Huang L.
        • Yin Y.
        • Yang L.
        • et al.
        Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children: a meta-analysis.
        JAMA Pediatr. 2017; 171: 426-434
        • Devin C.L.
        • D’Cruz R.
        • Linden A.F.
        • et al.
        Reducing resource utilization for patients with uncomplicated appendicitis through use of same-day discharge and elimination of postoperative antibiotics.
        J Pediatr Surg. 2020; 55: 2591-2595
        • Putnam L.R.
        • Levy S.M.
        • Johnson E.
        • et al.
        Impact of a 24-hour discharge pathway on outcomes of pediatric appendectomy.
        Surgery. 2014; 156: 455-461
        • Farach S.M.
        • Danielson P.D.
        • Walford N.E.
        • et al.
        Same-day discharge after appendectomy results in cost savings and improved efficiency.
        Am Surg. 2014; 80: 787-791
        • Alkhoury F.
        • Burnweit C.
        • Malvezzi L.
        • et al.
        A prospective study of safety and satisfaction with same-day discharge after laparoscopic appendectomy for acute appendicitis.
        J Pediatr Surg. 2012; 47: 313-316
        • Anderson K.T.
        • Bartz-Kurycki M.A.
        • Ferguson D.M.
        • et al.
        Too much of a bad thing: Discharge opioid prescriptions in pediatric appendectomy patients.
        J Pediatr Surg. 2018; 53: 2374-2377
        • Poonai N.
        • Paskar D.
        • Konrad S.-L.
        • et al.
        Opioid analgesia for acute abdominal pain in children: A systematic review and meta-analysis.
        Acad Emerg Med. 2014; 21: 1183-1192
        • Zhu A.
        • Benzon H.A.
        • Anderson T.A.
        Evidence for the efficacy of systemic opioid-sparing analgesics in pediatric surgical populations: a systematic review.
        Anesth Analg. 2017; 125: 1569-1587
        • Srouji R.
        • Ratnapalan S.
        • Schneeweiss S.
        Pain in children: assessment and nonpharmacological management.
        Int J Pediatr. 2010; 2010https://doi.org/10.1155/2010/474838
        • Hamill J.K.
        • Liley A.
        • Hill A.G.
        Intraperitoneal local anesthetic for laparoscopic appendectomy in children: a randomized controlled trial.
        Ann Surg. 2017; 266: 189-194
        • Podda M.
        • Gerardi C.
        • Cillara N.
        • et al.
        Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children: a systematic review and meta-analysis.
        Ann Surg. 2019; 270: 1028-1040
        • Georgiou R.
        • Eaton S.
        • Stanton M.P.
        • et al.
        Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis.
        Pediatrics. 2017; https://doi.org/10.1542/peds.2016-3003
        • Kessler U.
        • Mosbahi S.
        • Walker B.
        • et al.
        Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis.
        Arch Dis Child. 2017; 102: 1118-1124
        • Maita S.
        • Andersson B.
        • Svensson J.F.
        • et al.
        Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis.
        Pediatr Surg Int. 2020; 36: 261-269
        • Svensson J.F.
        • Patkova B.
        • Almström M.
        • et al.
        Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial.
        Ann Surg. 2015; 261: 67-71
        • Patkova B.
        • Svenningsson A.
        • Almström M.
        • et al.
        Nonoperative treatment versus appendectomy for acute nonperforated appendicitis in children: five-year follow up of a randomized controlled pilot trial.
        Ann Surg. 2020; 271: 1030-1035
        • Tanaka Y.
        • Uchida H.
        • Kawashima H.
        • et al.
        Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis.
        J Pediatr Surg. 2015; 50: 1893-1897
        • Hartwich J.
        • Luks F.I.
        • Watson-Smith D.
        • et al.
        Nonoperative treatment of acute appendicitis in children: A feasibility study.
        J Pediatr Surg. 2016; 51: 111-116
        • Minneci P.C.
        • Mahida J.B.
        • Lodwick D.L.
        • et al.
        Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis.
        JAMA Surg. 2016; 151: 408-415
        • Bachur R.G.
        • Rangel S.J.
        The threat of diagnostic uncertainty in the medical management of uncomplicated appendicitis.
        JAMA Pediatr. 2017; 171: 505-506
        • Litz C.N.
        • Stone L.
        • Alessi R.
        • et al.
        Impact of outpatient management following appendectomy for acute appendicitis: An ACS NSQIP-P analysis.
        J Pediatr Surg. 2018; 53: 625-628
        • AlFraih Y.
        • Robinson T.
        • Stein N.
        • et al.
        Quality assurance and performance improvement project for suspected appendicitis.
        Pediatr Qual Saf. 2020; 5: e290
        • American College of Surgeons’ Pediatric Surgical Quality Collaborative
        Reducing use of CT imaging in the diagnostic evaluation of suspected appendicitis in children.
        (Accessed December 28, 2020)
        • Glass C.C.
        • Saito J.M.
        • Sidhwa F.
        • et al.
        Diagnostic imaging practices for children with suspected appendicitis evaluated at definitive care hospitals and their associated referral centers.
        J Pediatr Surg. 2016; 51: 912-916
        • Kotagal M.
        • Richards M.K.
        • Chapman T.
        • et al.
        Improving ultrasound quality to reduce computed tomography use in pediatric appendicitis: the Safe and Sound campaign.
        Am J Surg. 2015; 209 (discussion 900): 896-900