title: High failure rate of nonoperative management of acute appendicitis with an appendicolith in children.
abstract: BACKGROUND
  The purpose of this study was to investigate the feasibility of nonoperative management of acute appendicitis in children with an appendicolith identified on preoperative imaging.
  
  
  METHODS
  We performed a prospective nonrandomized trial of nonoperative management of uncomplicated acute appendicitis with an appendicolith in children aged 7 to 17years. The primary outcome was the failure rate of nonoperative management, defined as having undergone an appendectomy. Early termination was set to occur if the lower limit of the 95% confidence interval of the failure rate was greater than 20% at 30days or 30% at 1year.
  
  
  RESULTS
  Recruitment for this study was halted after enrollment of 14 patients (N=5 nonoperative; N=9 surgery). The failure rate of nonoperative management was 60% (3/5) at a median follow-up of 4.7months (IQR 1.0-7.6) with a 95% CI of 23%-88%. None of the three patients that failed nonoperative management had complicated appendicitis at the time of appendectomy, while six out of nine patients who chose surgery had complicated appendicitis (0/3 vs. 6/9, p=0.18). The trial was stopped for concerns over patient safety.
  
  
  CONCLUSIONS
  Nonoperative management of acute appendicitis with an appendicolith in children resulted in an unacceptably high failure rate.
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Mahida
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Lodwick
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Nacion
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sulkowski
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Leonhart
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Cooper
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Ambeba
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH. Electronic address: Peter.Minneci@nationwidechildrens.org.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D002648:Child; D057239:Early Termination of Clinical Trials; D005240:Feasibility Studies; D005244:Fecal Impaction / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D017211:Treatment Failure
keywords: Appendectomy; Appendicitis; Appendicolith; Nonoperative management; Surgery