[Acute appendicitis. Usefulness of a evidence-based critical pathway].
OBJECTIVE
To determine the effects of an evidence-based clinical pathway for acute appendicitis in paediatric patients at a tertiary hospital.


METHODS
We studied 229 patients with an age range from 3 to 14 years, with a pathological diagnosis of acute appendicitis divided in two groups. A prospective, experimental clinical pathway group of children (n = 114), (June 1999-January 2001) was compared with a historical control prepathway group of patients treated by conventional means in the previous years, (n = 115), (December 1997-May 1999). Age, gender, type of appendicitis (uncomplicated/complicated), length of hospitalisation, number of antibiotics doses supplied and rates of complications, were compared between pathway and and control patients.


RESULTS
There were no differences in age (p = 0.61), gender (p = 0.73), either the number of complicated/uncomplicated appendicitis (p = 0.91) between the two groups. The average duration of hospitalisation was significantly shortened in pathway group (4.34 versus 5.33 days) (p = 0.000049) and the number of antibiotics doses were reduced from 16.13 to 11.17 doses (p = 0.000000). The number of major complications was lower in the pathway group than in the control group (6 and 16 respectively) but there was no significative difference (p = 0.09).


CONCLUSIONS
Clinical pathway is an efficient and safe tool for acute appendicitis because decrease the length of hospitalisation and the number of antibiotics doses supplied, while maintaining quality of care.
Gutiérrez Dueñas
J M
JM
Servicio de Cirugía Pediátrica, Hospital General Yagüe Avda, del Cid, 96, 09005 Burgos.
Lozano
F J
FJ
Díez Pascual
R
R
Ardela Díaz
E
E
García Arcal
D
D
Domínguez Vallejo
F J
FJ
D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome