Table 1.
Baseline characteristics of 30 participants with the diagnosis of acute uncomplicated appendicitis by treatment group.
| Characteristic | Appendectomy, n = 14 | Antibiotics-First, n = 16 |
|---|---|---|
| Age, median (IQR; range), y | 36 (33–46; 24–65) | 31 (25–40; 9–73) |
| Male sex, No. (%) | 9 (64.3) | 9 (56.3) |
| Race, No. (%) | ||
| White | 12 (85.7) | 13 (81.3) |
| Other | 2 (14.3) | 3 (18.8) |
| Hispanic ethnicity, No. (%) | 12 (85.7) | 14 (87.5) |
| Diabetes, No. (%) | 0 | 1 (6.3) |
| Body mass index, median (IQR; range), kg/m2 | 28.0 (24.6–29.8; 21.0–31.8) | 27.3 (25.1–33.0; 22.3–43.3) |
| Previous abdominal/pelvic surgery, No. (%) | 3 (21.4) | 3 (18.8) |
| Symptoms | ||
| Subjective fever, No. (%) | 4 (28.6) | 2 (12.5) |
| Nausea, No. (%) | 13 (92.9) | 12 (75.0) |
| Right lower quadrant pain, No. (%) | 13 (92.9) | 14 (87.5) |
| Duration of pain, median (IQR; range), days | 1.0 (0.5–3.0; 0.5–5.0) | 1.0 (1.0–2.5; 0.5–5.0) |
| Maximal pain before 24 h, median (IQR; range)* | 10 (8–10; 5–10) | 8 (8–10; 4–10) |
| Signs | ||
| Localized rebound tenderness, No. (%) | 10 (71.4) | 8 (50.0) |
| Localized guarding, No. (%) | 6 (42.9) | 6 (37.5) |
| Triage temperature, median (IQR; range), °C | 36.9 (36.6–36.7; 36.5–38.1) | 36.8 (36.7–37.2; 36.4–37.3) |
| CT findings† | ||
| Appendicolith, No. (%)‡ | 3 (21.4) | 2 (13.3) |
| Appendiceal diameter, median (IQR; range), mm | 9 (9–12; 7–8) | 10 (9–12; 7–14) |
| Periappendiceal stranding, No. (%) | 14 (100.0) | 13 (86.7) |
| Periappendiceal fluid, No. (%) | 3 (21.4) | 2 (13.3) |
| Laboratory results | ||
| WBC count, median (IQR; range), ×103/μL | 15.3 (11.0–18.4; 8.1–23.1) | 14.2 (11.3–17.0; 6.2–19.2) |
| Lactate, median (IQR; range), mmol/L§ | 1.0 (0.9–1.4; 0.6–1.6) | 1.1 (0.9–1.5; 0.7–2.3) |
| CRP, median (IQR; range), mg/L§ | 64.8 (42.6–101.6; 8.2–256.4) | 25.9 (10.8–64.8; 3.8–202.6) |
| Alvarado score, median (IQR; range)‖ | 8 (7–9; 4–10) | 8 (7–9; 4–10) |
| Appendix pathology findings, No. (%) | ||
| Normal | 1 (7.1) | |
| Acute uncomplicated | 9 (64.3) | NA |
| Suppurative or gangrenous | 4 (28.6) | |
| Quality-of-life measures | ||
| SF-12v2 Physical Component Score, median (IQR; range)¶ | 52.0 (47.4–57.0; 25.4–61.4) | 55.9 (54.4–57.1; 41.7–64.1) |
| SF-12v2 Mental Component Score, median (IQR; range)¶ | 57.0 (41.9–61.2; 31.6–68.4) | 49.4 (38.8–61.1; 35.5–62.1) |
IQR, Interquartile range; CRP, C-reactive protein; NA, not applicable.
Pain was rated on a scale of 0 to 10.
One pediatric participant randomized to antibiotics-first did not receive a CT scan, so results are presented only for the 15 adult participants who did.
Radiographic identification of an appendicolith was initially an exclusion criterion but was later allowed (after 11 of 30 participants were enrolled) because of lack of consistent evidence of this being a risk factor for antibiotic failure.
Two participants in the appendectomy group were missing results for lactate and CRP.
The Alvarado score28 consists of the following components (points): right lower quadrant tenderness (0/2), elevated temperature (≥37.3°C [99.1°F]) (0/1), rebound tenderness (0/1), migration of pain to the right lower quadrant (0/1), anorexia (0/1), nausea or vomiting (0/1), leukocytosis greater than 10,000 cells/μL (0/2), and polymorphonuclear cells greater than 75% (0/1).
SF-12v2 Health Survey Acute version24 (1-week recall) was used for adult (14 appendectomy and 15 antibiotic-first) participants to assess baseline quality of life before their appendicitis symptoms.