The Skeptics Guide to Emergency Medicine SGEM#476: Cuts like a Knife or Antibiotics for Pediatric Appendicitis
May 24, 2025
Dr. Camille Wu, a leading pediatric surgeon at Sydney Children’s Hospital, delves into the contentious debate over treating pediatric appendicitis. She discusses the growing role of antibiotics versus traditional surgeries, citing recent studies on treatment efficacy. The dialogue touches on the complexities of diagnosis and management, including cultural differences in practices between Australia and the US. Additionally, the conversation highlights patient perspectives and the emotional considerations impacting treatment choices, urging a more personalized approach.
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Antibiotics Inferior to Surgery
- Antibiotics alone for uncomplicated pediatric appendicitis are generally inferior to appendectomy.
- Most pediatric studies support surgery as the superior treatment approach.
Imaging Variability in Appendicitis
- Surgeons often diagnose pediatric appendicitis clinically, using imaging variably.
- ALARA principle limits CT use, so ultrasound is the primary imaging modality in pediatric hospitals.
Challenges in Perforation Diagnosis
- Distinguishing perforated from non-perforated appendicitis clinically is subjective and challenging.
- Duration of symptoms and age under five are crucial factors for suspicion of perforation.