None listed
Conditions
Brief summary
Abdominal pain is a common reason for children to attend the Emergency Department (ED), with acute appendicitis is the most frequent cause of abdominal pain requiring surgical intervention with the highest incidence occurring in 10-to-20-year olds. Ruling in and ruling out the diagnosis of appendicitis is the main concern for acute care clinicians confronted with a child with abdominal pain with various clinical prediction scores (CPSs) developed to assist with diagnosing appendicitis. Most CPSs involve calculating a score based on combinations of different clinical features and laboratory findings to classify patients into low, intermediate, or high risk for appendicitis. The most frequently used scores in children are the Alvarado score, Pediatric Appendicitis Score, and the pediatric Appendicitis Risk Calculator. In addition, several other scores have been postulated in the literature with varying degrees of application and accuracy in children. However, CPSs have been inadequately validated and haphazardly adopted in Australia and New Zealand (ANZ), resulting in an increasing number of children undergoing unnecessary imaging and laboratory investigations compared to previous clinical practice. This project aims to address this issue by externally validating various commonly used CPSs in children aged 5 to <18 years presenting to ANZ EDs with acute abdominal pain with the suspicion of appendicitis and compare the CPSs’ performances against local clinician gestalt. This will improve accuracy of diagnosis, reduce healthcare costs, rationalise the use of healthcare resources, and improve management of childhood appendicitis. It will also provide a description of the current diagnostic and management approaches in ANZ for paediatric abdominal pain and appendicitis.
Interventions
This is a study looking at clinical prediction scores for the diagnosis of paediatric appendicitis in children aged 5 to <18 years during their Emergency Department stay.
Data collected relating to their hospital presentation will include demographic data (sex, date of birth), eligibility (inclusion and exclusion criteria), clinician seniority and perceived likelihood of appendicitis on a Visual Analog Scale at a single time point at the point of care, history of presenting complaint (nature of
This is a study looking at clinical prediction scores for the diagnosis of paediatric appendicitis in children aged 5 to <18 years during their Emergency Department stay. Data collected relating to their hospital presentation will include demographic data (sex, date of birth), eligibility (inclusion and exclusion criteria), clinician seniority and perceived likelihood of appendicitis on a Visual Analog Scale at a single time point at the point of care, history of presenting complaint (nature of abdominal pain, anorexia, nausea, vomiting, dysuria/frequency), and examination findings (area of tenderness, presence of rebound/cough/percussion tenderness, abdominal guarding, Rovsing’s sign, nature of bowel sounds, abdominal rigidity, temperature), bloods (white cell count, absolute neutrophil count, neutrophilia, C-reactive protein), urinalysis (presence of leukocytes and/or nitrites); prehospital management; management and imaging undertaken elsewhere; time-related data (times of triage, clinician evaluation, ED and hospital discharge); duration of ED and hospital stay; admission status; specialty unit consultations; analgesia; observation duration; intensive care admission, related surgical interventions; other significant pathology or adverse events, and mortality. Besides the data about their hospital presentation that will be collected by clinicians with no active involvement from participants, follow up contact will be undertaken on all eligible patients except for the following cases: (1) parent/guardian declined follow up on initial presentation, (2) participant admitted under an inpatient medical or surgical team and no representation to ED within the follow up period of 30 days, or (3) participant identified by site research team to have experienced clinically significant adverse events. The follow-up contact planned to be conducted 30 days after presentation will be completed by the site research team. This will occur via a telephone call or email/text. A maximum of three contact attempts will be made with at least one telephone contact attempted after working hours. If more than 60 days have elapsed from the time of presentation, or if there have been three failed contact attempts, the patient follow-up will be regarded as unsuccessful. The medical record for patients unable to be reached will also be reviewed and if sufficient information is documented in the medical record, this information may be used to substitute for failed contact. The following data will be collected: relevant physician contacts; need for and duration of ED and/or hospital admissions including investigations (with review of the relevant medical record); duration of missing out on school/work; and related surgical interventions. The duration of observation will be all patients presenting to participating hospital EDs during the study period. This is anticipated to be approximately a year from the commencement of the project (mid 2023-early 2024) based on the estimated annual number of appendicitis seen at the participating hospital EDs.
Sponsors
Professor Meredith Borland
Eligibility
Sex/Gender
All
Age
5 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
1) Age 5 years to <18 years 2) Presentation with generalised or right-sided abdominal pain 3) Duration of pain for less than or equal to 7 days (less than or equal to 168 hours) 4) Clinician concern for the possible diagnosis of appendicitis as defined by: i. Investigations performed (bloods/imaging, including external investigations) ii. Surgical consultation to assess patient for appendicitis iii. Senior clinician consultation to assess patient for appendicitis iv. Period of observation in ED to re-assess patient for appendicitis
Exclusion criteria
1) Abdominal trauma which required medical review within last 7 days 2) Previous significant abdominal surgery (e.g. appendectomy, short gut, ileostomy, Hirschsprungs) 3) Chronic illnesses which may affect the abdomen (including inflammatory bowel disease, chronic pancreatitis, cystic fibrosis, sickle cell anaemia) 4) Pregnancy 5) Inability to obtain accurate history (e.g. parent/guardian unavailable, language other than English AND no interpreter available, or patient non-verbal due to pre-existing medical condition)
Outcome results
None listed