Abstract：
BACKGROUND: Conservative antibiotic treatment (CAT) for uncomplicated acute appendicitis (AUA) in children has been proven safe and efficacious. However, as data accumulate, high rates of recurrent appendicitis and subsequent appendectomy have been reported. This prospective longitudinal study evaluated risk-factors for recurrent AUA after CAT in a large cohort, with long-term follow-up.
METHODS: Children ages 5 to 16 years admitted to the Department of Pediatric Surgery from 2014 through 2018, diagnosed with AUA were eligible for CAT. We recorded their age, appendix outer diameter, white blood cell counts, C-reactive protein and other related signs and symptoms associated with AUA. Clinical and ultrasonographic follow-up was carried out until follow-up data collection ceased according to the study design (2014-2019).
RESULTS: The cohort included 646 children who were initially treated successfully with CAT. Among them, 180 (28%) were readmitted for recurrent acute appendicitis during the follow-up period and 138 (21%) eventually had appendectomy. Overall success of 79% for CAT was recorded in this cohort. A multivariable model including; age, sex, appendiceal diameter, WBC and CRP, found the factors of older age, larger outer appendiceal diameter and high WBC counts significantly related to appendectomy during the follow-up period. We offer a decision tree model to predict appendectomy probabilities for patients based on their prognostic measurements.
CONCLUSIONS: CAT in AUA in children should consider older age, larger outer appendiceal diameter and high WBC counts as risk-factors for recurrent AUA and subsequent appendectomy. The proposed decision tree model may help both clinicians and parents before CAT is chosen.
METHODS: Level 2.
METHODS: Children ages 5 to 16 years admitted to the Department of Pediatric Surgery from 2014 through 2018, diagnosed with AUA were eligible for CAT. We recorded their age, appendix outer diameter, white blood cell counts, C-reactive protein and other related signs and symptoms associated with AUA. Clinical and ultrasonographic follow-up was carried out until follow-up data collection ceased according to the study design (2014-2019).
RESULTS: The cohort included 646 children who were initially treated successfully with CAT. Among them, 180 (28%) were readmitted for recurrent acute appendicitis during the follow-up period and 138 (21%) eventually had appendectomy. Overall success of 79% for CAT was recorded in this cohort. A multivariable model including; age, sex, appendiceal diameter, WBC and CRP, found the factors of older age, larger outer appendiceal diameter and high WBC counts significantly related to appendectomy during the follow-up period. We offer a decision tree model to predict appendectomy probabilities for patients based on their prognostic measurements.
CONCLUSIONS: CAT in AUA in children should consider older age, larger outer appendiceal diameter and high WBC counts as risk-factors for recurrent AUA and subsequent appendectomy. The proposed decision tree model may help both clinicians and parents before CAT is chosen.
METHODS: Level 2.
摘要：
背景：儿童无并发症急性阑尾炎（AUA）的保守抗生素治疗（CAT）已被证明是安全有效的。然而,随着数据的积累，据报道，复发性阑尾炎和随后的阑尾切除术的发生率很高。这项前瞻性纵向研究评估了一项大型队列中CAT后复发AUA的危险因素，长期随访。
方法：2014年至2018年儿科外科收治的5至16岁、诊断为AUA的儿童符合CAT标准。我们记录了他们的年龄,附录外径,白细胞计数,C反应蛋白和其他相关体征和症状与AUA相关。根据研究设计（2014-2019），进行临床和超声检查随访，直到随访数据收集停止。
结果：该队列包括646名最初成功接受CAT治疗的儿童。其中,在随访期间，有180例（28％）因复发性急性阑尾炎而再次入院，有138例（21％）最终进行了阑尾切除术。在该队列中,CAT的总成功率为79%。多变量模型，包括；年龄，性别,阑尾直径,WBC和CRP,发现了年龄较大的因素，在随访期间,较大的阑尾外直径和较高的白细胞计数与阑尾切除术显著相关.我们提供了一个决策树模型来根据患者的预后测量结果预测患者的阑尾切除术概率。
结论：儿童AUA中的CAT应考虑年龄较大，较大的阑尾外直径和较高的白细胞计数是AUA复发和随后阑尾切除术的危险因素.所提出的决策树模型可以在选择CAT之前帮助临床医生和父母。
方法：二级。
方法：2014年至2018年儿科外科收治的5至16岁、诊断为AUA的儿童符合CAT标准。我们记录了他们的年龄,附录外径,白细胞计数,C反应蛋白和其他相关体征和症状与AUA相关。根据研究设计（2014-2019），进行临床和超声检查随访，直到随访数据收集停止。
结果：该队列包括646名最初成功接受CAT治疗的儿童。其中,在随访期间，有180例（28％）因复发性急性阑尾炎而再次入院，有138例（21％）最终进行了阑尾切除术。在该队列中,CAT的总成功率为79%。多变量模型，包括；年龄，性别,阑尾直径,WBC和CRP,发现了年龄较大的因素，在随访期间,较大的阑尾外直径和较高的白细胞计数与阑尾切除术显著相关.我们提供了一个决策树模型来根据患者的预后测量结果预测患者的阑尾切除术概率。
结论：儿童AUA中的CAT应考虑年龄较大，较大的阑尾外直径和较高的白细胞计数是AUA复发和随后阑尾切除术的危险因素.所提出的决策树模型可以在选择CAT之前帮助临床医生和父母。
方法：二级。
