title: Response-based therapy for ruptured appendicitis reduces resource utilization.
abstract: OBJECTIVE
  We examined the effectiveness of a postoperative ruptured appendicitis protocol that eliminated Pseudomonas coverage and based the duration of IV antibiotic treatment and length of hospital stay on the patient's clinical response.
  
  
  METHODS
  In our new protocol, IV antibiotics were administered until the patient met discharge criteria: adequate oral intake, pain control with oral medications, and afebrile for 24h. We collected data on all patients with ruptured appendicitis at our institution following protocol implementation (May 1, 2012, to April 30, 2013) and compared them to a control group.
  
  
  RESULTS
  306 patients were treated (154 prior protocol, 152 new protocol). The new clinical response-based protocol led to a decrease in hospital stay from 134h (SD 66.1) to 94.5h (SD 61.7) (p<0.001) and total cost of care per patient also decreased from $13,610 (SD $6859) to $9870 (SD $5670) (p<0.001).
  
  
  CONCLUSIONS
  Our clinical response-based protocol for pediatric patients with ruptured appendicitis decreased LOS, cost, and IV antibiotics use without significant changes in adverse events.
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT. Electronic address: david.skarda@imail.org.
authors.forename: David E
authors.initials: DE
authors.lastname: Skarda
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Kathy
authors.initials: K
authors.lastname: Schall
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Michael
authors.initials: M
authors.lastname: Rollins
authors.affiliation: Systems Improvement Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Seth
authors.initials: S
authors.lastname: Andrews
authors.affiliation: Department of Pharmacology, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Jared
authors.initials: J
authors.lastname: Olson
authors.affiliation: University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT.
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.affiliation: University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT.
authors.forename: Molly
authors.initials: M
authors.lastname: McFadden
authors.affiliation: University of Utah School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Salt Lake City, UT.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Thorell
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Doug
authors.initials: D
authors.lastname: Barnhart
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Rebecka
authors.initials: R
authors.lastname: Meyers
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Eric
authors.initials: E
authors.lastname: Scaife
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001064:Appendicitis / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000191:economics; D008297:Male; D011182:Postoperative Care / Q000191:economics* / Q000379:methods*; D012422:Rupture, Spontaneous
chemical_list: D000900:Anti-Bacterial Agents
keywords: Appendicitis; Cost; Length of stay; Pediatric; Protocol; Ruptured