Appendectomy vs. Symptomatic Treatment in Uncomplicated Acute Appendicitis Among Pediatric Patients

Launched by HELSINKI UNIVERSITY CENTRAL HOSPITAL · Mar 11, 2022

Keywords

ClinConnect Summary

The APPSYPP trial is a study that aims to compare two different treatments for children aged 7 to 15 who have been diagnosed with uncomplicated acute appendicitis, which is a condition where the appendix becomes inflamed but has not caused any serious complications. In this trial, some children will receive an emergency surgery called an appendectomy to remove the appendix, while others will receive symptomatic treatment, which means they will be given care to manage their symptoms without surgery. The goal is to see which approach is more effective in treating this condition.

To participate in this trial, children must be between 7 and 15 years old, have imaging tests like an ultrasound or MRI showing uncomplicated appendicitis, and have a certain level of a blood marker called CRP. Participants can expect to be closely monitored in a hospital setting, especially those receiving symptomatic treatment, which includes receiving fluids and pain relief for at least 24 hours. The study will track their recovery for 30 days to determine how well each treatment works and if there are any complications. This research is important as it may help doctors decide the best way to treat pediatric appendicitis in the future.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • age 7-15 years
• • clinical diagnosis of uncomplicated acute appendicitis confirmed by US and/or MRI: adequately visualized appendix with a diameter of 6.1-11.0 mm without evidence of perforation, abscess, appendicolith or tumor suspicion
• • CRP ≤ 65 mg/l
• Exclusion Criteria:
• • inability to give informed consent
• • age under 7 or over 15 years
• • antibiotic administration within 14 days prior to enrolment
• • any previous treatment for acute appendicitis
• • severe nausea and/or vomiting preventing oral fluid intake
• • systemic disease potentially compromising the safety of symptomatic treatment of acute appendicitis (e.g. type 2 diabetes, malignancy, immune deficiency, or a medical condition requiring immunosuppressant medication)
• • diffuse peritonitis or complicated acute appendicitis at imaging (perforation, abscess, appendicolith or tumor suspicion)
• • inadequately visualized appendix
• • age and sex adjusted BMI over 27 kg/m2 and no MRI performed
• • CRP \> 65 mg/l.