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Led by Dr. Shawn St. Peter, from Children's Mercy Hospital in Kansas City, USA, the APPY clinical trial involved clinician-researchers from 11 pediatric hospitals worldwide, including Dr. Marianne Beaudin and Dr. Nelson Piché, from CHU Sainte-Justine and the Department of Surgery at the University of Montreal. The results will help guide the choice of treatment for this surgical emergency that affects a large number of children and adolescents.
Conducted from January 2016 to December 2021, the APPY trial involved 936 patients aged 5 to 16 seen at one of the participating pediatric hospitals, including 96 at CHU Sainte-Justine, who were suspected of having non-perforating appendicitis.
The young patients were randomly prescribed either intravenous antibiotics or appendectomy. The study then compared the failure rates of these two treatment options.
For appendectomy, failure was defined as finding during surgery that the appendix was normal (7% of cases). As for antibiotic treatment, it was considered a failure if an appendectomy was required within the following year (34%).
Conclusion: antibiotics allow young patients to recover more quickly, but have a failure rate more than 20% higher than surgery, in addition to leading to a longer hospital stay.
A study that sets the record straight
"Our results show that about one-third of patients treated with antibiotics still need to undergo an appendectomy within a year of their treatment, most often within the first 100 days," explains Dr. Beaudin, a pediatric surgeon at CHU Sainte-Justine and professor at the University of Montreal. "It's important to know this, as some smaller-scale studies suggest that antibiotics have equivalent efficacy to surgery. That's not the case."
These results are important to support clinicians' decision-making, but also to guide discussions between the child, parents, and healthcare team: "Knowing the exact failure rates of each option will allow doctors to discuss treatment choices based on evidence and families to make informed decisions based on these results," emphasizes Dr. Piché, also a pediatric surgeon at CHU Sainte-Justine and professor at the University of Montreal.