Evidence map›Paper›PMID 27974169›Full record

Trial reportAnnals of emergency medicine2017

Antibiotics-First Versus Surgery for Appendicitis: A US Pilot Randomized Controlled Trial Allowing Outpatient Antibiotic Management.

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 and 2 more

Abstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of emergency medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 8 pooled it
14.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 8 syntheses or guidelines pooled it, 109 citations in OpenAlex.

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  3. Appendectomy versus antibiotic treatment for acute appendicitis.The Cochrane database of systematic reviews · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 3 institutions in 1 country.

David A TalanDepartment of Emergency Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Medicine, Division of Infectious Diseases, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: dtalan@ucla.edu.
Darin J SaltzmanDepartment of Surgery, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
William R MowerDepartment of Emergency Medicine, Ronald Reagan Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Anusha KrishnadasanDepartment of Emergency Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Cecilia M JudeDepartment of Radiology, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Ricky AmiiDepartment of Emergency Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Daniel A DeUgarteDivision of Pediatric Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
James X WuDepartment of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Kavitha PathmarajahDepartment of Emergency Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Ashkan MorimDepartment of Emergency Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Gregory J MoranDepartment of Emergency Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Medicine, Division of Infectious Diseases, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Olive View–UCLA Appendicitis Study Group
Olive View-UCLA Medical Center · USUniversity of California, Los Angeles · USRonald Reagan UCLA Medical Center · US

Funding

Pilot Randomized Trial of Antibiotics vs Surgery for Treating Acute AppendicitisR21DK102048 · NIDDK · OLIVE VIEW-UCLA EDUCATION AND RES INST · PI TALAN, DAVID ANDREW · 2014 to 2015
$333k
NIDDK NIH HHS R21 DK102048
6 · The paper itself

Abstract

STUDY

objectiveRandomized trials suggest that nonoperative treatment of uncomplicated appendicitis with antibiotics-first is safe. No trial has evaluated outpatient treatment and no US randomized trial has been conducted, to our knowledge. This pilot study assessed feasibility of a multicenter US study comparing antibiotics-first, including outpatient management, with appendectomy.

methodsPatients aged 5 years or older with uncomplicated appendicitis at 1 US hospital were randomized to appendectomy or intravenous ertapenem greater than or equal to 48 hours and oral cefdinir and metronidazole. Stable antibiotics-first-treated participants older than 13 years could be discharged after greater than or equal to 6-hour emergency department (ED) observation with next-day follow-up. Outcomes included 1-month major complication rate (primary) and hospital duration, pain, disability, quality of life, and hospital charges, and antibiotics-first appendectomy rate.

resultsOf 48 eligible patients, 30 (62.5%) consented, of whom 16 (53.3%) were randomized to antibiotics-first and 14 (46.7%) to appendectomy. Median age was 33 years (range 9 to 73 years), median WBC count was 15,000/μL (range 6,200 to 23,100/μL), and median computed tomography appendiceal diameter was 10 mm (range 7 to 18 mm). Of 15 antibiotic-treated adults, 14 (93.3%) were discharged from the ED and all had symptom resolution. At 1 month, major complications occurred in 2 appendectomy participants (14.3%; 95% confidence interval [CI] 1.8% to 42.8%) and 1 antibiotics-first participant (6.3%; 95% CI 0.2% to 30.2%). Antibiotics-first participants had less total hospital time than appendectomy participants, 16.2 versus 42.1 hours, respectively. Antibiotics-first-treated participants had less pain and disability. During median 12-month follow-up, 2 of 15 antibiotics-first-treated participants (13.3%; 95% CI 3.7% to 37.9%) developed appendicitis and 1 was treated successfully with antibiotics; 1 had appendectomy. No more major complications occurred in either group.

conclusionA multicenter US trial comparing antibiotics-first to appendectomy, including outpatient management, is feasible to evaluate efficacy and safety.

Indexed as

AppendectomyAdministration, IntravenousAdolescentAdultAgedAnti-Bacterial AgentsAppendicitisbeta-LactamsCefdinirCephalosporinsChildCost-Benefit AnalysisDrug Therapy, CombinationErtapenemFeasibility StudiesFemaleAnti-Bacterial Agentsbeta-LactamsCefdinirCephalosporinsErtapenemMetronidazole

Identifiers

PMID27974169
PMCPMC5616169
OpenAlexW2560587690

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.