eP17 Evaluating the Impact of the Children's Appendicitis Score on the Management of Suspected Paediatric Appendicitis at a District General Hospital
Abdul-Hadi Kafagi, Luke Peaple, Carley FrerichsAbstract
Introduction
Appendicitis is a common cause of abdominal pain in children and presents diagnostic challenges due to varied clinical presentations. This audit evaluates the management of suspected paediatric appendicitis at a District General Hospital, comparing it with the GIRFT Paediatric Acute Abdominal Pain Pathway. Our goal was to assess the impact of the Children's Appendicitis Score (CAS) on clinical decision-making and refine practices among emergency clinicians, paediatricians, general surgeons and radiologists.
Methods
A retrospective review of patient data from November 2023 to May 2024 for children under 16 was conducted. CAS scores were assigned based on clinical notes and key patient journey times were analysed. Data on baseline characteristics, initial assessments, imaging and surgical outcomes were recorded.
Results
Of 103 patients, 30 underwent appendectomy, with a negative appendectomy rate of 13.3% (4/30). The remaining 73 were discharged with non-surgical abdominal pain or other diagnoses. CAS demonstrated 100% sensitivity and negative predictive value in low-risk patients (n=36), effectively ruling out appendicitis. Among intermediate-risk patients (n=44), 32% were diagnosed with appendicitis, while 78% of high-risk patients (n=18) had the condition. CAS identified 2 negative appendectomies and highlighted an intermediate-risk patient who was discharged and later returned with a perforated appendix. Of 82 abdominal ultrasounds performed, 26 (31.7%) were deemed inappropriate for low-risk patients, with 86.36% sensitivity and 92.73% specificity.
Conclusion
Integrating CAS into the management of suspected paediatric appendicitis improves risk stratification, reduces unnecessary interventions and enhances diagnostic precision. CAS allows confident discharge of low-risk patients, optimising resource use and patient outcomes.