Project Summary
Appendicitis is one of the most common causes of abdominal pain in both adults and children. The standard treatment for appendicitis is an operation to remove the appendix, called an appendectomy. Over 250,000 appendectomies are performed every year in the United States; 70,000 of these are performed in children. Although less than 10 percent of patients will experience a complication following appendectomy, the procedure is associated with pain and disability following surgery. A non-operative management strategy to treat appendicitis with antibiotics alone instead of surgery may be preferred by patients and families, given its potential for less negative impact on the child and family. This study will determine how well non-operative management works in children with early appendicitis at 10 hospitals. The most important results we will examine are
- the amount of time the child misses from everyday activities (disability for the child) and
- the success of non-operative management at one year.
Other important results include disability for the caregiver, quality of life after treatment, satisfaction with care, percentage of patients with worse appendicitis (complicated appendicitis), and treatment complications.
Our research team comprises various stakeholders, each of whom represents a different perspective. These partners are an integral part of our research team. They include pediatric patients, families, primary care practitioners, specialized physicians, payers, and health educators. Non-English-speaking persons, lower-income families, and both parent and grandparent caregivers are represented within the subgroup of family stakeholders. Together, this diverse group of individuals agreed that we should perform a patient choice trial that allows for families to choose the best treatment option for their child. They felt this would respect the family’s preferences for a particular treatment, make patients and families from different backgrounds feel comfortable participating in the study, and allow our results to be easily used at other hospitals. Our stakeholder partners also helped us choose which results to measure in order to provide patients and families the information they need to make an informed decision between non-operative management and surgery. All of our stakeholders have agreed to ongoing participation, including monitoring study progress and assisting in dissemination plans.
We expect non-operative management to be successful in 75 percent of patients at one-year follow-up, and to cause less disability and fewer complications than surgery. If non-operative management is proved effective, three out of every four patients would never need surgery, meaning that over 45,000 patients each year would not experience the pain and disability that occurs after surgery or be put at risk for a complication from surgery.
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