None listed
Conditions
Brief summary
Our objective is to assess the performance of the Paediatric Appendicitis Risk Calculator in an Australian tertiary emergency department and to compare its performance with that of the Paediatric Appendicitis Score (PAS) in predicting risk of appendicitis. This will also be compared to the Alvarado Score for predicting appendicitis. The pARC was developed in 2018 to quantify risk of appendicitis on a continuous scale for patients presenting with acute abdominal pain. Variables that are assessed include duration of pain, fever, nausea or vomiting, pain with walking, hopping or coughing, migration of pain to right lower quadrant, maximal tenderness in right lower quadrant, abdominal guarding, white blood cell count and absolute neutrophil count. The initial study found that the pARC accurately quantified risk for appendicitis, in an American setting, with nearly half of the patients accurately classified as <15% risk or >85% risk for appendicitis. None of the above risk calculators have been investigated in Australian paediatric hospitals. Patients with abdominal pain, where appendicitis is a differential, often require transfer to tertiary centres, imaging and diagnostic surgical intervention, and the utilisation of these calculators could significantly change how patients are managed in the emergency department. This study’s purpose is to determine if the pARC is an appropriate calculator to be utilised to predict the appendicitis in the paediatric population. This may then be utilised as a tool in the emergency department to assist physicians to determine if patients presenting with abdominal pain in the emergency department, where appendicitis is a differential, to help assist in the patient’s clinical journey.
Interventions
Prospectively collect data and validate if the Paediatric Appendicitis Risk Calculator (pARC) score is useful in determining the risk of appendicitis in an Australian setting.
Parameters observed include symptoms of the patient's abdominal pain including the duration of pain, location of pain, and migration of pain to right side. Clinical signs are assessed, these include guarding, percussion/cough/rebound tenderness, pain with walking and right lower quadrant tenderness. Presence of anorexia,
Prospectively collect data and validate if the Paediatric Appendicitis Risk Calculator (pARC) score is useful in determining the risk of appendicitis in an Australian setting. Parameters observed include symptoms of the patient's abdominal pain including the duration of pain, location of pain, and migration of pain to right side. Clinical signs are assessed, these include guarding, percussion/cough/rebound tenderness, pain with walking and right lower quadrant tenderness. Presence of anorexia, nausea, vomiting and the patient's temperature are also recorded. Results of bedside ultrasound, formal ultrasound, blood sampling results and if an operation is performed, the histology report are also collected. The clinician's suspicion of appendicitis is also recorded. There is no active participation for the participants. This is purely an observational study and there is no change in management. If blood tests are taken as clinically necessary, they are recorded. The observation period for each patient is their initial presentation to the emergency department and they will either be followed up as they have undergone an operation and appendicitis is confirmed, or they will be discharged and followed up via a text message within 2 - 3 weeks of their initial presentation to ensure there are no appendicitis diagnosis' which are missed. The total duration of the observation is all ED presentations at the Women's and Children's Hospital for abdominal pain where appendicitis is a differential, over the next 18 months.
Sponsors
Alexander Howes
Eligibility
Sex/Gender
All
Age
5 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
Children 5yo to 18yo Abdominal pain – generalised or right sided <5 days duration (120 hours) Initial presentation with abdominal pain Where appendicitis is a differential diagnosis Patients with significant co-morbidities can be included however noted that they may have confounders. (eg. autism, type 1 diabetes, type 2 diabetes, thyroid disease, congenital cardiac disease)
Exclusion criteria
Testicular pain Pain >120 hours duration Previous appendicectomy Previous bowel surgery, IBD, chronic pancreatitis, CF, sickle cell disease Medical condition preventing ability to obtain accurate history – eg non verbal Transplant patients Abdominal trauma within 2 weeks Pregnant Appendicitis identified prior to initial presentation to hospital
Outcome results
None listed