Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences.
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.
Aprahamian
Charles J
CJ
Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
Barnhart
Douglas C
DC
Bledsoe
Samuel E
SE
Vaid
Yoginder
Y
Harmon
Carroll M
CM
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
D000900:Anti-Bacterial Agents