title: Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences.
abstract: BACKGROUND
  The initial nonoperative management of perforated appendicitis fails in 15% to 25% of children. These children have complications and increased hospitalization. The purpose of this study was to identify predictors of failure.
  
  
  METHODS
  Children with perforated appendicitis treated with antibiotics and intent for nonoperative management over a 4-year period were reviewed. Seventy-five children were identified and included in the study. Failure was defined as undergoing appendectomy before the initially planned interval.
  
  
  RESULTS
  Nine (12%) of the patients required appendectomy sooner than initially planned. Age, presenting symptoms, physical examination findings, and white blood cell (WBC) count were similar in both success and failure groups. Absence of abscess and presence of appendicolith were both predictors of failure in a multivariate analysis, which included the presence of small bowel obstruction. The failed group had a longer median total length of stay (18 days [range, 4-67] vs 8 days [range, 4-31]; P = .002) and underwent 3 times as many computed tomography scans as successes (3 [range, 2-7] vs 1 [range, 0-5]; P < .001).
  
  
  CONCLUSIONS
  Lack of abscess and presence of an appendicolith predict failure of nonoperative management of perforated appendicitis in children even when the effect of small bowel obstruction is accounted for. Children with these characteristics may benefit from alternative management strategies.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Aprahamian
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Bledsoe
authors.forename: Yoginder
authors.initials: Y
authors.lastname: Vaid
authors.forename: Carroll M
authors.initials: CM
authors.lastname: Harmon
mesh_terms: D000038:Abscess / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D002137:Calculi / Q000453:epidemiology; D002429:Cecal Diseases / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D007958:Leukocyte Count; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents