Journal article
Patient-centered outcomes research in appendicitis in children: Bridging the knowledge gap
Journal of pediatric surgery, v 51(1), 117
Jan 2016
PMID: 26545589
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Patient-centered outcomes research (PCOR) aims to give patients a better understanding of the treatment options to enable optimal decision-making. As nonoperative alternatives are now being evaluated in children for acute appendicitis, we surveyed patients and their families regarding their knowledge of appendicitis and evaluated whether providing basic medical information would affect their perception of the disease and allow them to more rationally consider the treatment alternatives.
Families of children aged 5–18 presenting to the Emergency Department with suspected appendicitis were recruited for a tablet-based interactive educational survey. One hundred subjects (caregivers and patients ≥15years) were questioned before and after an education session about their understanding of appendicitis, including questions on three hypothetical treatment options: urgent appendectomy, antibiotics alone, or initial antibiotics followed by elective appendectomy. Subjects were clearly informed that urgent appendectomy is currently the standard of care.
Only 14% of respondents correctly identified the mortality rate of appendicitis (17 deaths/year according to the 2010 US census) when compared with other extremely rare causes of death. Fifty-four and 31% thought it was more common than death from lightning (40/year) and hunting-associated deaths (44/year), respectively. Eighty-two percent of respondents believed it “likely” or “very likely” that the appendix would rupture if operation was at all delayed, and 81% believed that rupture of the appendix would rapidly lead to severe complications and death. In univariate analysis, this perception was significantly more prevalent for mothers (odds ratio, (OR) 5.19, confidence interval (CI) 1.33–21.15), and subjects who knew at least one friend or relative who had a negative experience with appendicitis (OR 5.53, CI 1.40–25.47). Following education, these perceptions changed significantly (53% still believed that immediate operation was necessary, and 47% believed perforation led to great morbidity and potential mortality, P<0.001). In a survey of potential appendicitis treatment options, urgent appendectomy was considered a “good” or “very good” option by 74% of subjects, compared with 68% for antibiotics only without appendectomy and 49% for initial antibiotic therapy followed by elective outpatient appendectomy.
There was a striking knowledge gap in the participant perception of appendicitis. Appropriate education can correct anecdotally supported misconceptions. Adequate education may empower patients to make better-informed decisions about their medical care and may be important for future studies in alternative treatments for appendicitis in children.
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Details
- Title
- Patient-centered outcomes research in appendicitis in children: Bridging the knowledge gap
- Creators
- Danielle B. Chau - Hasbro Children's HospitalSean S. Ciullo - Hasbro Children's HospitalDebra Watson-Smith - Hasbro Children's HospitalThomas H. Chun - Hasbro Children's HospitalArlet G. Kurkchubasche - Hasbro Children's HospitalFrancois I. Luks - Brown University
- Publication Details
- Journal of pediatric surgery, v 51(1), 117
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:000367696600023
- Scopus ID
- 2-s2.0-84952920047
- Other Identifier
- 991021448027404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Pediatrics
- Surgery