ABSTRACT
BACKGROUND: Appendicitis is the commonest paediatric surgical emergency. Adult studies suggest non-operative management (NOM) may have a place in care. There have been no adequately powered randomized controlled trials in children. OBJECTIVE: to determine the safety and efficacy of NOM for paediatric simple appendicitis. METHODS: A non-inferiority randomized controlled trial was conducted comparing operative (OM) to NOM of SA in children aged five-15 years. Primary outcome was treatment success (no unplanned or unnecessary operation, or complication) at 30 days and 12 months, with a non-inferiority margin of 15%. (anzctr.org.au: ACTRN12616000788471). RESULTS: From 11 June 2016 to 30 November 2020, 222 children were randomized: 94 (42.34%) to OM and 128 (57.66%) to NOM. Non-inferiority of NOM was not demonstrated at either time point, with 45.67% of NOM patients subsequently undergoing operation. There was no significant difference in complications. CONCLUSIONS: While noninferiority was not shown, NOM was safe, with no difference in adverse outcomes between the two groups. Further research to refine the place of NOM of simple appendicitis in children is required, including nuanced patient selection, longer term evaluation, the place of choice, and the acceptability of the treatment for children and their carers.
ABSTRACT
Burns are a common mechanism of pediatric injury worldwide and are a notable cause of disability-adjusted life-years. Burns in children represent a unique challenge, due to the differences from adults regarding physical characteristics, physiology and psychology. This retrospective cohort study examined trends of pediatric burns in New South Wales (NSW), Australia from 2010-22. It specifically focused on the changes in burn etiology and patient characteristics, body area affected, total body surface area, first aid, location and management. It also compared a 'Pre-COVID-19' and 'Peri-COVID-19' era to analyze the impact of COVID-19 on the pattern of pediatric burns, as children are at higher risk of injury during times of social disruption. The study found that burns in children continue to be concentrated in the toddler and preschooler age group and the main mechanisms of injury remain as scald and contact burns. In recent years, there has been a rising trend of friction burns, alongside a fall in flame burns and severe burns. Management of pediatric burns has also evolved, with predominant use of ambulatory care and low rates of admission and operative intervention. Trends in burn injury continue to evolve with time and over the last decade in NSW, key changes in the pattern of pediatric burns have been observed, with evolving mechanisms of injury, reduced severity of burns and a shift towards ambulatory care.
