The Grand Rounds session will be held on Friday, June 7, 2024, at 1:00 pm eastern.
Rothman is a professor of internal medicine, pediatrics, and health policy, the Ingram Professor of Integrative and Population Health, and the senior vice president for population and public health at Vanderbilt University Medical Center. He also serves as the director of Vanderbilt’s Institute for Medicine and Public Health. Block is an associate professor of population medicine at Harvard Medical School, a faculty member in the Harvard Center for Population and Development Studies, and a general internal medicine physician at Brigham and Women’s Hospital.
The CODA (Comparing Outcomes of Drugs and Appendectomy) Collaborative involved 25 sites across 14 states. The Co-PIs included surgeons and emergency medicine physicians.
The CODA pragmatic trial aimed to inform the health decision for appendicitis treatment by asking two research questions:
Are antibiotics as effective as appendectomy for appendicitis?
Which patients are most likely to have a successful outcome with antibiotics?
Instead of appendectomy, the intervention group received antibiotics intravenously for 24 hours followed by pills for a total of 10 days. The primary outcome in the trial was 30-day health status, as assessed with the European Quality of Life-5 Dimensions questionnaire.
The patients who received antibiotics cared about outcomes such as “Am I going to feel better,” followed by “Is it safe,” and “Will I return to work sooner?”
Discussion Themes
Antibiotics for appendicitis can be a good choice for some but not all. Decision-makers must weigh patient characteristics, preferences, and circumstances.
Can you comment on the relative “disappearance” of appendicitis during the COVID-19 pandemic?
Based on your results, how would you counsel a patient (or parent) in the emergency department with a diagnosis of appendicitis?
Will there eventually be a biomarker that’s predictive for appendectomy?
