"About 20 percent of the kids with appendicitis who came here had uncomplicated appendicitis, which is would what I would expect to see at any major children's hospital," he says, adding that the results from their study are similar to those from a series of European studies performed in adults that have found that in most cases, appendicitis doesn't require surgery at all.
To study the option further, Drs. Deans and Minneci are coordinating efforts by 10 other pediatric hospitals in the Midwest Pediatric Surgical Consortium to enroll as many 800 children over the next few years in similar trials.
"With our pilot project, we started with the group of patients who would be most likely to have success with an antibiotics-only approach and would be least likely to be harmed, but the next step is to try to slowly add some of the patients who were excluded in the preliminary study to see how well they do," Dr. Minneci says. "It may get to the point that nonoperative management becomes the initial therapy for all appendicitis, but we won't know that until we do further studies."
As with the pilot project, future studies will follow a patient-choice model, meaning participants will not be randomized to one treatment group or the other.
"Patients are more likely to participate in research if they are able to make a choice and not be randomized to one of the two treatment options," Dr. Minneci says. "That is something that's different about this trial."
The notion of involving parents and patients in the decision-making process is under study in a related project led by Drs. Deans and Minneci. Funded by a $1.6 million grant from the Patient-Centered Outcomes R
|Contact: Gina Bericchia|
Nationwide Children's Hospital