- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05724628
Non-operative vs. Operative Management of Acute Appendicitis in Vulnerable Patient Populations
A Pilot Randomized Trial of Non-operative Versus Operative Management of Acute Appendicitis in Vulnerable Patient Populations
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The study would involve consented subjects, once confirmed eligible to proceed after screening, will be randomly assigned to two arms:
- Group 1 - Operative Group - Operation will be performed to remove appendix.
- Group 2 - Non-operative group - No operation will be performed, and instead the subject will receive intra-venous (IV) antibiotics, transitioned to by mouth (oral) antibiotics, for treatment of appendicitis.
Aside from the routine hospital care, participants will be asked to fill out a survey for cognitive function (CAM Assessment Form), pain (Visual Analog Scale), and quality of life at the start and end of participant's hospital stay, 1-2 weeks after discharge, and again at 6 weeks after discharge from the initial hospital visit.
Participants will also be asked to participate in a qualitative interview, either by virtual visit, site visit, or phone call, at 1-2 weeks and again at about 6 weeks after discharge from the hospital. Each interview will be approximately 20-30 minutes of the participant's time.
Study Type
Phase
- Phase 1
Contacts and Locations
Study Contact
- Name: Ana Garzon
- Phone Number: 469/571-0840
- Email: Ana.Garzon@UTSouthwestern.edu
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥18 years
- Able to consent for the study
- Diagnosis of acute appendicitis confirmed by CT imaging
Exclusion Criteria:
- Appendicolith/fecalith on imaging
- Chronic or recurrent appendicitis
- Having received prior antibiotic treatment for other reasons within 5 days prior to study enrollment
- Hemodynamically abnormal (SBP<90 mmHg, Heart Rate (HR) >120, mmHg, Partial Pressure of Oxygen in Arterial Blood (PaO2<60), or potential of Hydrogen (pH<7.3)).
- Inability to tolerate general anesthesia (determined by surgery and anesthesiology teams)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Operative Arm
Operation (laparoscopic appendectomy) will be performed to remove appendix.
|
Subjects will receive surgery (using 3 port Laparoscopic appendectomy) to remove appendix
|
Experimental: Non-Operative Arm
No operation will be performed, and instead, will receive intra-venous (IV) antibiotics, transitioned to by mouth (oral) antibiotics
|
Subjects will be admitted to the hospital for antibiotic treatment, initially with IV antibiotics and then transitioned to by mouth (PO) antibiotics for the rest of the course. Drugs used would be anything from: zosyn, ciprofloxacin or ceftriaxone and flagyl, augmentin |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility of the intervention as measured by the proportion of enrolled participants retained in this study
Time Frame: 12 months post treatment
|
Feasibility of the intervention is measured by the proportion of enrolled participants who are randomized and retained in this study
|
12 months post treatment
|
Feasibility of the intervention as measured by the number of complications or adverse events
Time Frame: 12 months post treatment
|
Feasibility of the intervention is measured by the number of complications or adverse events encountered by participants while enrolled in this study
|
12 months post treatment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility of the intervention as measured by total length of hospital stay (Antibiotics Group)
Time Frame: the day of discharge (approx. 1-3 days post treatment)
|
Feasibility of the intervention is measured by total number of days in inpatient hospital stay for the IV antibiotics group post treatment
|
the day of discharge (approx. 1-3 days post treatment)
|
Feasibility of the intervention as measured by total length of hospital stay (Operative Group)
Time Frame: the day of discharge (approx. 0-2 days post treatment)
|
Feasibility of the intervention is measured by total number of days in inpatient hospital stay for the Operative group post laparoscopic appendectomy
|
the day of discharge (approx. 0-2 days post treatment)
|
Feasibility of the intervention as measured by the number of hospital readmissions or emergency room visits
Time Frame: 1-2 weeks post-discharge
|
Feasibility of the intervention is measured by the count of the number of hospital readmissions or emergency room visits by the participants at 1-2 weeks post-discharge
|
1-2 weeks post-discharge
|
Feasibility of the intervention as measured by the number of hospital readmissions or emergency room visits
Time Frame: 6 weeks post-discharge
|
Feasibility of the intervention is measured by the count of the number of hospital readmissions or emergency room visits by the participants at 6 weeks post-discharge
|
6 weeks post-discharge
|
Feasibility of the intervention as measured by QoL surveys
Time Frame: prior to discharge home (approx. 4-6 hours post treatment)
|
Feasibility of the intervention is measured by administering Quality of Life (QoL) surveys using Quality of Recovery-40 questionnaire.
This is a self-rated questionnaire for early postoperative quality of recovery and health status of patients.
Possible scores range from 1 to 5, where higher scores indicate better quality of life (i.e., 1 = very poor and 5 = excellent)
|
prior to discharge home (approx. 4-6 hours post treatment)
|
Feasibility of the intervention as measured by QoL surveys
Time Frame: 1-2 weeks post-discharge
|
Feasibility of the intervention is measured by administering Quality of Life (QoL) surveys using Quality of Recovery-40 questionnaire.
This is a self-rated questionnaire for early postoperative quality of recovery and health status of patients.
Possible scores range from 1 to 5, where higher scores indicate better quality of life (i.e., 1 = very poor and 5 = excellent)
|
1-2 weeks post-discharge
|
Feasibility of the intervention as measured by QoL surveys
Time Frame: 6 weeks post-discharge
|
Feasibility of the intervention is measured by administering Quality of Life (QoL) surveys using Quality of Recovery-40 questionnaire.
This is a self-rated questionnaire for early postoperative quality of recovery and health status of patients.
Possible scores range from 1 to 5, where higher scores indicate better quality of life (i.e., 1 = very poor and 5 = excellent)
|
6 weeks post-discharge
|
Change in pain score from baseline as measured by visual analog pain scale at prior to discharge home (approx. 4-6 hours post treatment)
Time Frame: Baseline, prior to discharge home (approx. 4-6 hours post treatment)
|
Change in pain score from baseline is measured by visual analog pain scale at prior to discharge home (approx.
4-6 hours post treatment).
Possible scores range from 0-10, where 0= no pain and 10= worst pain.
|
Baseline, prior to discharge home (approx. 4-6 hours post treatment)
|
Change in pain score from baseline as measured by visual analog pain scale at 1-2 weeks post discharge
Time Frame: Baseline, 1-2 weeks post discharge
|
Change in pain score from baseline is measured by visual analog pain scale at weeks post discharge.
Possible scores range from 0-10, where 0= no pain and 10= worst pain.
|
Baseline, 1-2 weeks post discharge
|
Change in pain score from baseline as measured by visual analog pain scale at 6 weeks post discharge
Time Frame: Baseline, 6 weeks post discharge
|
Change in pain score from baseline is measured by visual analog pain scale at 6 weeks post discharge.
Possible scores range from 0-10, where 0= no pain and 10= worst pain.
|
Baseline, 6 weeks post discharge
|
Change in cognitive function as measured by CAM assessment form at 1-2 weeks post discharge
Time Frame: Baseline, 1-2 weeks post discharge
|
Change in cognitive function is measured by Short Confusion Assessment Method (CAM) Questionnaire at 1-2 weeks post discharge.
If Inattention and at least one other item ( regarding acute change in mental status; inattention) in Box 1 of the questionnaire are checked and at least one item (regarding disorganized thinking; altered level of consciousness) in Box 2 of the questionnaire is checked, then a diagnosis of delirium is suggested.
|
Baseline, 1-2 weeks post discharge
|
Change in cognitive function as measured by CAM assessment form at 6 weeks post discharge
Time Frame: Baseline, 6 weeks post discharge
|
Change in cognitive function is measured by Short Confusion Assessment Method (CAM) Questionnaire at 6 weeks post discharge.
If Inattention and at least one other item ( regarding acute change in mental status; inattention) in Box 1 of the questionnaire are checked and at least one item (regarding disorganized thinking; altered level of consciousness) in Box 2 of the questionnaire is checked, then a diagnosis of delirium is suggested.
|
Baseline, 6 weeks post discharge
|
Feasibility of the intervention as measured by physical function using FRAIL scale
Time Frame: Baseline
|
Feasibility of the intervention is measured by physical function using FRAIL scale.
The Fatigue Resistance Ambulation Illness and Loss of weight (FRAIL) scale includes 5 components: Fatigue, Resistance, Ambulation, Illness, and Loss of weight.
Frail scale scores range from 0-5 (i.e., 1 point for each component; 0=best to 5=worst) and represent frail (3-5), pre-frail (1-2), and robust (0) health status.
|
Baseline
|
Feasibility of the intervention as measured by hospital costs for each enrolled participant (Antibiotics Group)
Time Frame: the day of discharge (approx. 1-3 days post treatment)
|
Feasibility of the intervention is measured by accessing billing codes/hospital costs for each enrolled subject from the time they are admitted until they are discharged from the hospital.
|
the day of discharge (approx. 1-3 days post treatment)
|
Feasibility of the intervention as measured by hospital costs for each enrolled participant (Operative Group)
Time Frame: the day of discharge (approx. 0-2 days post treatment)
|
Feasibility of the intervention is measured by accessing billing codes/hospital costs for each enrolled subject from the time they are admitted until they are discharged from the hospital.
|
the day of discharge (approx. 0-2 days post treatment)
|
Collaborators and Investigators
Investigators
- Principal Investigator: Sneha Bhat, UT Southwestern Medical Center
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- STU-2021-0035
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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