The management of pediatric appendicitis: a survey of North American Pediatric Surgeons.
OBJECTIVE
Variation exists among pediatric surgeons in the management of pediatric appendicitis. The goal of this study was to determine current practice patterns and provide a foundation for evidence-based outcome studies that would standardize patient care.


METHODS
Members of the American Pediatric Surgical Association (APSA) were surveyed. Data included preference of imaging, timing of operation, and opinions on interval appendectomy. Intraoperative principles surveyed included use of cultures, antibiotic irrigation, transperitoneal drains, and method of wound closure. Spectrum and duration of antibiotic coverage were assessed, as were discharge criteria.


RESULTS
Survey response was 70%. A majority prefers computerized tomographic (CT) imaging and favors interval appendectomy in appropriate candidates. Seventy percent indicate a stable child with suspected appendicitis would be operated on in a semiurgent manner rather than emergently in their practice. Discrepancy exists in the type and duration of antibiotic coverage, impact of clinical parameters on antibiotic use, and utility of discharge criteria.


CONCLUSIONS
This study consolidates current opinions on appropriate management of pediatric appendicitis, providing a foundation for evidence-based outcome studies capable of bringing conformity to the management of this surgical disease. Such studies would establish clinical practice guidelines that optimize resource utilization while maintaining quality care.
Muehlstedt
Steven G
SG
Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX, USA.
Pham
Trey Q
TQ
Schmeling
David J
DJ
D000293:Adolescent; D000900:Anti-Bacterial Agents; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D002097:C-Reactive Protein / Q000032:analysis; D019090:Case Management / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003625:Data Collection; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000706:statistics & numerical data; D007958:Leukocyte Count; D009656:North America; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012955:Societies, Medical / Q000706:statistics & numerical data; D013536:Suture Techniques; D013997:Time Factors
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein