title: Saline vs Tissue Plasminogen Activator Irrigations after Drain Placement for Appendicitis-Associated Abscess: A Prospective Randomized Trial.
abstract: BACKGROUND
  Emerging data suggest instillation of tissue plasminogen activator (tPA) is safe and potentially efficacious in the treatment of intra-abdominal abscess. To date, prospective comparative data are lacking in children. Therefore, we conducted a randomized trial comparing abscess irrigation with tPA and irrigation with saline alone.
  
  
  METHODS
  After IRB approval, children with an abscess secondary to perforated appendicitis who had a percutaneous drain placed for treatment were randomized to twice-daily instillation of 13 mL 10% tPA or 13 mL normal saline. All patients were treated with once-daily dosing of ceftriaxone and metronidazole throughout their course. The primary end point variable was duration of hospitalization after drain placement. Using a power of 0.8 and an α of 0.05, a sample size of 62 patients was calculated.
  
  
  RESULTS
  Sixty-two patients were enrolled between January 2009 and February 2013. There were no differences in demographics, abscess size, abscess number, admission WBC, or duration of symptoms. Duration of hospitalization after drainage was considerably longer with the use of tPA. There was no difference in total duration of hospitalization, days of drainage, or days of antibiotics. However, medication charges were higher with tPA.
  
  
  CONCLUSIONS
  There are no advantages to routine tPA flushes in the treatment of abdominal abscess secondary to perforated appendicitis in children.
authors.affiliation: Department of Surgery, The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO. Electronic address: sspeter@cmh.edu.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: Department of Surgery, The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Sohail R
authors.initials: SR
authors.lastname: Shah
authors.affiliation: Department of Surgery, The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Obinna O
authors.initials: OO
authors.lastname: Adibe
authors.affiliation: Department of Surgery, The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Sharp
authors.affiliation: Department of Radiology, The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Brent
authors.initials: B
authors.lastname: Reading
authors.affiliation: Department of Radiology, The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Brent
authors.initials: B
authors.lastname: Cully
authors.affiliation: Department of Surgery, The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO.
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.affiliation: Department of Radiology, The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Rivard
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001064:Appendicitis / Q000150:complications*; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004322:Drainage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D011446:Prospective Studies; D016037:Single-Blind Method; D012965:Sodium Chloride / Q000627:therapeutic use*; D007507:Therapeutic Irrigation; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D005343:Fibrinolytic Agents; D008795:Metronidazole; D012965:Sodium Chloride; D002443:Ceftriaxone; D010959:Tissue Plasminogen Activator