Pediatricians

Importance: Nonoperative management (NOM) has emerged as a potential alternative to surgery for acute uncomplicated appendicitis in children; however, while short-term outcomes are often favorable, concerns remain about treatment durability, complication rates, and long-term failure. An updated meta-analysis of randomized clinical trials (RCTs) may help clarify the comparative safety and effectiveness of NOM vs appendectomy.

Objective: To evaluate the safety and effectiveness of NOM compared with appendectomy for uncomplicated appendicitis in children using the highest level of available evidence.

Data sources: A systematic review of PubMed, Embase, Scopus, Cochrane, and Web of Science was conducted from inception through March 2025 to identify randomized clinical trials comparing NOM with surgical management in pediatric patients.

Study selection: RCTs comparing NOM vs surgical management in pediatric patients younger than 18 years were included. Nonrandomized and quasi-randomized studies were excluded.

Data extraction and synthesis: Data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses were conducted using random-effects models. Risk of bias was assessed independently by multiple reviewers. Trial sequential analysis was performed to determine whether the evidence was sufficiently robust and conclusive.

Main outcomes and measures: The primary outcomes were treatment failure and treatment success in 1 year and major complications (Clavien-Dindo grade ≥IIIb). Secondary outcomes included time to return to school and time to return to normal activity.

Results: Of 1246 studies screened, 7 RCTs, including 1480 pediatric patients, met inclusion criteria. Treatment failure was significantly higher in the NOM group than in the appendectomy group at 1 year (risk ratio [RR], 4.97; 95% CI, 3.57-6.91; I2 = 0.0%). Treatment success was significantly lower in the NOM group at 1 year (RR, 0.67; 95% CI, 0.60-0.75; I2 = 31.1%). Major complications classified as Clavien-Dindo grade IIIb or worse were more frequent in the NOM group (RR, 33.37; 95% CI, 7.89-141.05; I2 = 9.5%). Appendicitis recurred at a rate of 18.47 events/100 observations (95% CI, 12.62-25.07 events/100 observations; I2 = 48.5%) among patients who received NOM. NOM, compared with appendectomy, was associated with a modestly faster return to school (mean difference, -1.36 days; 95% CI, -2.64 to -0.08 days; P = .04; I2 = 57.7%) and return to normal activities (-4.93 days; 95% CI, -8.68 to -1.19 days; P = .01; I2 = 87.2%), although this may be offset by subsequent readmissions or reintervention. Trial sequential analysis demonstrated the robustness and conclusiveness of primary outcomes.

Conclusions and relevance: In contrast to earlier studies, this meta-analysis found significantly higher treatment failure and major complication rates within a year with NOM among children and adolescents. The meta-analysis provides pediatricians and pediatric surgeons with up-to-date data to inform shared decision-making with families and encourage individualized, patient-centered treatment.

Author/s:

Isabella Faria, Ana Carolina Godinho Cintra, Luiz Gustavo Albuquerque Mello de Oliveira

Stimulant Management of Attention-Deficit/Hyperactivity Disorder for the Pediatric Prescriber: A Review of Stimulant-Dosing Strategies and An Overview of New Stimulants

Alex Haga — Thu, 16 Jan 2025 18:49:56 +0000

Date Added:

January 16, 2025

Journal/Publication:

Pediatric Annals

Publication Date:

January 1, 2025

Issue:

Volume:

Pages:

e22-e26

URL:

Stimulant Management of Attention-Deficit/Hyperactivity Disorder for the Pediatric Prescriber: A Review of Stimulant-Dosing Strategies and An Overview of New Stimulants

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.3928/19382359-20241007-06

Keywords

Pediatricians

adolescent

ADHD

PMID (1):

39760345

MeSH

adolescent

Attention Deficit Disorder with Hyperactivity* / drug therapy

Pediatricians

Central Nervous System Stimulants* / therapeutic use

A review of the use of stimulants for management of symptoms in children with ADHD. James W. Mold, MD, MPH

Free full text

View

Pediatricians are often the first providers to assess and treat attention-deficit/hyper-activity disorder (ADHD) in youth. While a variety of pharmacological and psychosocial interventions exist for ADHD, stimulants remain the first-line medication treatment. Many stimulant formulations now exist, providing the pediatric prescriber with a diverse repertoire of treatment options. This article is tailored to the pediatric prescriber in the primary care setting and discusses stimulant management, with emphasis on dosing equivalencies, common stimulant-dosing strategies, and newer stimulants.

Author/s:

Courtney Romba, Jasleen Singh

Get SET Early to Identify and Treatment Refer Autism Spectrum Disorder at 1 Year and Discover Factors That Influence Early Diagnosis

Devin Evans — Thu, 29 Apr 2021 05:00:00 +0000

Date Added:

April 29, 2021

Journal/Publication:

The Journal of Pediatrics

Publication Date:

April 26, 2021

URL:

Get SET Early to Identify and Treatment Refer Autism Spectrum Disorder at 1 Year and Discover Factors That Influence Early Diagnosis

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2021.04.041

Keywords

MeSH

A summary of the impact of screening all children at 12, 18, and 24 months for autism. James W. Mold, MD, MPH

Free full text

View

Objectives

To examine the impact of a new approach, Get SET Early, on the rates of early autism spectrum disorder (ASD) detection and factors that influence the screen-evaluate-treat chain.

Study design

Following Get SET Early training, 203 pediatricians administered 57,603 total screens using the Communication and Symbolic Behavior Scales Infant-Toddler Checklist at 12, 18, and 24-month well-baby examinations, and parents designated presence or absence of concern. For screen-positive toddlers, pediatricians specified if the child was being referred for evaluation, and if not, why not.

Results

Collapsed across ages, toddlers were evaluated and referred for treatment at a median age of 19 months, and those screened at 12 months (59.4% of sample) by 15 months. Pediatricians referred one-third of screen-positive toddlers for evaluation, citing lack of confidence in the accuracy of screen-positive results as the primary reason for non-referral. If a parent expressed concerns, referral probability doubled, and the rate of an ASD diagnosis increased 37%. Of 897 toddlers evaluated, almost half were diagnosed as ASD, translating into an ASD prevalence of 1%.

Conclusions

The Get SET Early model was effective at detecting ASD and initiating very early treatment. Results also underscored the need for change in early identification approaches to formally operationalize and incorporate pediatrician judgement and level of parent concern into the process.

Author/s:

Pierce, K., Gazestani, V., Bacon, E., Gyurjyan, G., Cook-Clark, T., Karins, K., Courchesne, E., Cheng, A., Barnes, C.C., Nalabolu, S., Cha, D., Arias, S., Lopez, L., Pham, C.