{"title":"阑尾炎激增:贝尔法斯特皇家儿童医院在COVID-19激增期间对儿科阑尾炎的管理。","authors":"D Colvin, S Lawther","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Traditional surgical dogma is that paediatric appendicitis necessitates an appendicectomy; however there is an increasing cohort of evidence suggesting that non-operative management (NOM) using antibiotic therapy is safe and effective. During the COVID-19 surge (April - June 2020) with centralization of paediatric surgical care and risks from anaesthetics to both patients and staff a NOM pathway was used to manage clinically diagnosed appendicitis in the Royal Belfast Hospital for Sick Children (RBHSC).</p><p><strong>Methods: </strong>Prospective data collection was undertaken of all children (<16 years) diagnosed with appendicitis who entered the NOM pathway in RBHSC from 01/04/2020 to 30/06/2020. This was compared to a cohort from the same timeframe in 2019. Primary end-points were inpatient success rate of NOM and 30-day success rate of NOM (success defined as no appendectomy performed).</p><p><strong>Results: </strong>47 patients completed the NOM pathway, with 43% (20/47) suspected to have complicated appendicitis. The cohort was similar to that of 2019 in terms of age (p=0.1) and sex (p=0.8), but was 155% larger (42 v. 20).For those with simple appendicitis, there was a 96% (26/27) success rate of NOM on discharge, with a 93% (25/27) 30-day success rate. For complicated appendicitis, there was a 40% (8/20) success rate on discharge, with a 30% (6/20) 30-day success rate.</p><p><strong>Conclusion: </strong>The use of a NOM pathway for paediatric appendicitis during the COVID-19 surge in Northern Ireland was safe and effective for staff and patients. With a small sample size and restricted follow up more evidence is required to prove if this is an effective treatment modality with a return to normal theatre availability. In the interests of antibiotic stewardship we would not advocate NOM pathways utilisation by non-surgical clinicians.</p>","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"90 2","pages":"86-89"},"PeriodicalIF":0.0000,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/43/umj-90-02-86.PMC8278940.pdf","citationCount":"0","resultStr":"{\"title\":\"A <i>surge</i> in appendicitis: Management of paediatric appendicitis during the COVID-19 surge in the Royal Belfast Hospital for Sick Children.\",\"authors\":\"D Colvin, S Lawther\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Traditional surgical dogma is that paediatric appendicitis necessitates an appendicectomy; however there is an increasing cohort of evidence suggesting that non-operative management (NOM) using antibiotic therapy is safe and effective. During the COVID-19 surge (April - June 2020) with centralization of paediatric surgical care and risks from anaesthetics to both patients and staff a NOM pathway was used to manage clinically diagnosed appendicitis in the Royal Belfast Hospital for Sick Children (RBHSC).</p><p><strong>Methods: </strong>Prospective data collection was undertaken of all children (<16 years) diagnosed with appendicitis who entered the NOM pathway in RBHSC from 01/04/2020 to 30/06/2020. This was compared to a cohort from the same timeframe in 2019. Primary end-points were inpatient success rate of NOM and 30-day success rate of NOM (success defined as no appendectomy performed).</p><p><strong>Results: </strong>47 patients completed the NOM pathway, with 43% (20/47) suspected to have complicated appendicitis. The cohort was similar to that of 2019 in terms of age (p=0.1) and sex (p=0.8), but was 155% larger (42 v. 20).For those with simple appendicitis, there was a 96% (26/27) success rate of NOM on discharge, with a 93% (25/27) 30-day success rate. For complicated appendicitis, there was a 40% (8/20) success rate on discharge, with a 30% (6/20) 30-day success rate.</p><p><strong>Conclusion: </strong>The use of a NOM pathway for paediatric appendicitis during the COVID-19 surge in Northern Ireland was safe and effective for staff and patients. With a small sample size and restricted follow up more evidence is required to prove if this is an effective treatment modality with a return to normal theatre availability. In the interests of antibiotic stewardship we would not advocate NOM pathways utilisation by non-surgical clinicians.</p>\",\"PeriodicalId\":38815,\"journal\":{\"name\":\"Ulster Medical Journal\",\"volume\":\"90 2\",\"pages\":\"86-89\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2021-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/43/umj-90-02-86.PMC8278940.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ulster Medical Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/7/8 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ulster Medical Journal","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/7/8 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
背景:传统的外科教条认为小儿阑尾炎需要阑尾切除术;然而,越来越多的证据表明,非手术治疗(NOM)使用抗生素治疗是安全有效的。在2019冠状病毒病高峰期间(2020年4月至6月),儿科外科护理集中,麻醉对患者和工作人员都有风险,贝尔法斯特皇家病童医院(RBHSC)采用NOM途径来管理临床诊断的阑尾炎。方法:对所有患儿进行前瞻性数据收集。结果:47例患儿完成了NOM通路,其中43%(20/47)怀疑合并阑尾炎。该队列在年龄(p=0.1)和性别(p=0.8)方面与2019年相似,但大了155% (42 vs 20)。单纯性阑尾炎患者,出院时手术成功率96%(26/27),30天手术成功率93%(25/27)。对于复杂性阑尾炎,出院时成功率为40%(8/20),30天成功率为30%(6/20)。结论:在北爱尔兰COVID-19激增期间,使用NOM途径治疗儿科阑尾炎对工作人员和患者是安全有效的。由于样本量小,随访受限,需要更多的证据来证明这是否是一种有效的治疗方式,可以恢复正常的手术室可用性。为了抗生素管理的利益,我们不提倡非手术临床医生使用NOM途径。
A surge in appendicitis: Management of paediatric appendicitis during the COVID-19 surge in the Royal Belfast Hospital for Sick Children.
Background: Traditional surgical dogma is that paediatric appendicitis necessitates an appendicectomy; however there is an increasing cohort of evidence suggesting that non-operative management (NOM) using antibiotic therapy is safe and effective. During the COVID-19 surge (April - June 2020) with centralization of paediatric surgical care and risks from anaesthetics to both patients and staff a NOM pathway was used to manage clinically diagnosed appendicitis in the Royal Belfast Hospital for Sick Children (RBHSC).
Methods: Prospective data collection was undertaken of all children (<16 years) diagnosed with appendicitis who entered the NOM pathway in RBHSC from 01/04/2020 to 30/06/2020. This was compared to a cohort from the same timeframe in 2019. Primary end-points were inpatient success rate of NOM and 30-day success rate of NOM (success defined as no appendectomy performed).
Results: 47 patients completed the NOM pathway, with 43% (20/47) suspected to have complicated appendicitis. The cohort was similar to that of 2019 in terms of age (p=0.1) and sex (p=0.8), but was 155% larger (42 v. 20).For those with simple appendicitis, there was a 96% (26/27) success rate of NOM on discharge, with a 93% (25/27) 30-day success rate. For complicated appendicitis, there was a 40% (8/20) success rate on discharge, with a 30% (6/20) 30-day success rate.
Conclusion: The use of a NOM pathway for paediatric appendicitis during the COVID-19 surge in Northern Ireland was safe and effective for staff and patients. With a small sample size and restricted follow up more evidence is required to prove if this is an effective treatment modality with a return to normal theatre availability. In the interests of antibiotic stewardship we would not advocate NOM pathways utilisation by non-surgical clinicians.