Management of children with possible appendicitis: A survey of emergency physicians in Australia and New Zealand

Mc Cabe, Kieran, Babl, Franz E., Dalton, Sarah, Paediatric Research in Emergency Departments International Collaborative (PREDICT) and Herd, David (2014) Management of children with possible appendicitis: A survey of emergency physicians in Australia and New Zealand. EMA - Emergency Medicine Australasia, 26 5: 481-486. doi:10.1111/1742-6723.12272


Author Mc Cabe, Kieran
Babl, Franz E.
Dalton, Sarah
Paediatric Research in Emergency Departments International Collaborative (PREDICT)
Herd, David
Title Management of children with possible appendicitis: A survey of emergency physicians in Australia and New Zealand
Journal name EMA - Emergency Medicine Australasia   Check publisher's open access policy
ISSN 1742-6723
1742-6731
Publication date 2014-10
Year available 2014
Sub-type Article (original research)
DOI 10.1111/1742-6723.12272
Open Access Status
Volume 26
Issue 5
Start page 481
End page 486
Total pages 6
Place of publication Richmond, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2015
Language eng
Formatted abstract
Objectives
To describe current practice in managing children with possible acute appendicitis in EDs in Australia and New Zealand as the basis for a clinical practice guideline (CPG).

Methods
An anonymous survey was distributed to consultant emergency physicians working at PREDICT (Paediatric Research in Emergency Departments International Collaborative) sites in Australia and New Zealand in April 2013. A second, site-based survey was distributed to the PREDICT representatives at each of the 13 sites.

Results
The response rate was 100% (13/13) for the site-based survey and 82% (145/176) for the physician survey. Most respondents agreed that right lower quadrant (RLQ) tenderness (94%), anorexia (92%), migration of abdominal pain to the RLQ (86%), rebound tenderness in the RLQ (60%) and RLQ tenderness produced on coughing, hopping or percussion (63%) were valuable symptoms and signs in diagnosing appendicitis. The responses regarding nausea and vomiting and fever were less consistent. Less than 50% regarded blood tests (C-reactive protein, white cell count) as relevant for the diagnosis of appendicitis. Most physicians (61%) agreed there was a role for a validated CPG for possible appendicitis in children, although only 3/13 sites reported use of such a CPG.

Conclusions
This survey of senior emergency physicians across Australia and New Zealand demonstrated congruence in several clinical markers and disagreements in others in the approach to diagnosing children with possible appendicitis. Whereas emergency physicians would like a validated CPG, this survey has highlighted some critical issues. Particularly, the low regard for blood tests, integral to published diagnostic scoring systems, will be a challenge for the development and introduction of such a CPG in Australia and New Zealand.
Keyword Abdominal pain
Appendicitis
Clinical practice guideline
Paediatric appendicitis score
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
Non HERDC
Official Audit
 
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