Papers of the Week

To assess nonoperative management (NOM) of uncomplicated appendicitis (UC-appy) in children to determine factors influencing prognosis and review the literature. All UC-appy cases presenting younger than 16 years between 2015 and 2018 who had NOM (one dose of intravenous analgesia and intravenous piperacillin/tazobactam 112.5 mg/kg 8 hourly) and were followed up for at least 3 months were reviewed prospectively ( = 146). Perceived pain and fever were assessed 12 hourly, biochemistry daily. If predetermined cutoff results were not achieved at each assessment, NOM was abandoned and urgent laparoscopic appendectomy (ULA) performed. NOM succeeded in 48.6% (S-NOM;  = 71) and failed in 51.4% (F-NOM;  = 75). Mean age at presentation (10.7 ± 2.5 versus 8.6 ± 3.7 years old;  < .0001) and duration of preadmission fever (1.0 ± 0.9 versus 2.1 ± 1.2 days;  < .0001) were the only significantly different criteria between S-NOM and F-NOM. Optimal cutoff values using receiver operating characteristic curve analysis were 7.0 years old (32% sensitivity and 93% specificity) and 1.0 day (95% sensitivity and 25% specificity), respectively. NOM was abandoned for persistent pain, prolonged fever, or raised white blood count at 12 hours in 20/75 (26.7%), 24 hours in 31/75 (41.3%), 36 hours in 14/75 (18.7%), and 48-72 hours in 10/75 (13.3%). At ULA, perforation was identified in 14/75 (18.7%). Complications arising within 3 months of ULA were residual abscess ( = 7/75; 9.3%) and transient ileus ( = 1/75; 1.3%). It would appear that surgery may be more appropriate for children with UC-appy when they are younger and febrile before admission for longer.