EP 018 Closed Loop Audit: Assessing the Children’s Appendicitis Score
Tze Yi Gan, Jayan George, Adith Thomas, Iqra Ahmed, Harue Yoshida, Tim WilsonAbstract
Aims
The Children’s Appendicitis Score (CAS) is used in our region to triage children with suspected appendicitis and streamline referral to surgery. This audit was to assess compliance with the pathway and evaluate our paediatric appendicitis service.
Methods
A retrospective audit/service review was conducted of patients assessed by the paediatric service for suspected appendicitis during November 2024. After educational sessions to promote the use of CAS, a second audit cycle was conducted during August 2025.
Results
11 patients were analysed in the initial audit and 8 patients in the second cycle. In the first cycle, the use of CAS (9%) was poor and all 11 cases were referred for surgical opinion. Only 6 (55%) ended up having appendicectomy. There was a slight improvement in the use of CAS in the second audit cycle (25%) and the proportion of referrals to surgery reduced to (6/8) 75%, with a higher proportion 4/6 (67%) taken to theatre. All patients operated on had histologically confirmed appendicitis. 1stCycle2ndCycleMale: Female7:45:3Median age (range)14 (5-15)11 (8-15)Documented CAS9% (1/11)25% (2/8)Surgical referral100% (11/11)75% (6/8)Theatre55% (6/11)67% (4/6)
Conclusion
Use of CAS remained poor, even after promotion through education. There is some indication that its wider use of may reduce the need for surgical review of all patients. Rates of negative appendicectomy remain low regardless of its use. Further work will be undertaken to assess the barriers to the wider use of CAS.