Evidence map›Paper›PMID 30421265›Full record

Trial reportEuropean journal of pediatrics2019

Clinical recovery in children with uncomplicated appendicitis undergoing non-operative treatment: secondary analysis of a prospective cohort study.

Max Knaapen, Johanna H van der Lee, Hugo A Heij, Ernst L W van Heurn, Roel Bakx, Ramon R Gorter

Registry-linked trialOpen access · hybridAbstract readClinical TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of pediatrics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01356641 (Antibiotic Treatment Alone for Acute Simple Appendicitis in Children; a Prospective Cohort Study Part of the Antibiotic Versus Primary Appendectomy in Children), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
3.8field-weighted citation impact, top 6% 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.

NCT01356641 nacompletednot on this map

Antibiotic Treatment Alone for Acute Simple Appendicitis in Children; a Prospective Cohort Study Part of the Antibiotic Versus Primary Appendectomy in Children (APAC) Trial

TypeinterventionalSponsorRamon R. GorterRan2012 to 2017Enrolled50ConditionsAppendicitisArmsAntibiotic treatment alone, Appendectomy
3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
  6. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 2 countries.

Max KnaapenPediatric Surgical Center of Amsterdam, Emma Children's Hospital and VU University Medical Center, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. m.knaapen@amc.uva.nl.ORCID http://orcid.org/0000-0002-0780-6395
Johanna H van der LeePediatric Clinical Research Office, Academic Medical Center, Emma Children's Hospital and VU University Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Hugo A HeijPediatric Surgical Center of Amsterdam, Emma Children's Hospital and VU University Medical Center, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
Ernst L W van HeurnPediatric Surgical Center of Amsterdam, Emma Children's Hospital and VU University Medical Center, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
Roel BakxPediatric Surgical Center of Amsterdam, Emma Children's Hospital and VU University Medical Center, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
Ramon R GorterPediatric Surgical Center of Amsterdam, Emma Children's Hospital and VU University Medical Center, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
Emma Kinderziekenhuis · NLUniversity Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Non-operative treatment of uncomplicated appendicitis in children is gaining ground. Pending definitive evidence regarding its effectiveness, there is a call to evaluate clinical recovery after non-operative treatment. In this study, we analyzed data collected during initial admission of a multicenter prospective cohort in which children, 7-17 year, were treated non-operatively for uncomplicated appendicitis. During admission clinical parameters (pain and gastro-intestinal symptoms), inflammation parameters and sequential abdominal ultrasound were recorded. In total, 45 children were included, 42(93%) were discharged without the need for appendectomy; median [IQR] pain scores on admission were 5 [4-7], decreasing to 2 [0-3] after 1 day of treatment. Initially, 28/42 (67%) reported nausea and 19/42 (45%) vomiting; after 1 day, this was 3/42 (7%) and 1/42 (2%), respectively. White blood cell count declined from a median [IQR] of 12.9 [10.7-16.7] 10E9/L on admission to 7.0 [5.8-9.9] 10E9/L on day 1. Median [IQR] C-reactive protein levels increased from 27.5 [9-69] mg/L on admission to 48 [22-80] mg/L on day 1, declining to 21.5 [11-42] mg/L on day 2. Follow-up ultrasound showed no signs of complicated appendicitis in any of the patients.Conclusion: Clinical symptoms resolved in most children after 1 day of non-operative treatment. This suggests that non-operative treatment is a viable alternative to appendectomy regarding clinical recovery.Trail registration: NCT01356641 What is Known: • Non-operative treatment of uncomplicated appendicitis in children is safe and its use around the world is gaining ground, however high quality evidence from adequately designed randomized trials is still lacking. • Concerns have been raised regarding the potentially prolonged clinical recovery associated with non-operative treatment. What is New: • Most clinical symptoms resolve after 1 day of non-operative treatment in the majority of children.

Indexed as

Abdominal PainAdolescentAnti-Bacterial AgentsAppendectomyAppendicitisChildCohort StudiesConservative TreatmentFecal ImpactionFemaleFollow-Up StudiesHumansLength of StayMaleNetherlandsPain MeasurementAnti-Bacterial AgentsClinical recoveryNon-operative treatmentPediatric surgeryUncomplicated appendicitis

Identifiers

PMID30421265
PMCPMC6339679
OpenAlexW2900613084

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

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.