SP 10.07 The PAPAYA (Paediatric Appendicitis Pathway and Audit Yield Assessment) Study: National Variation in Paediatric Appendicitis Pathways and its Impact on Negative Rate of Appendicectomy
Georgios Karagiannidis, Evie Banham, Aneeka Pervez, Jie Ying Tee, Jared Wohlgemut, Martin SinclairAbstract
Background
Negative appendicectomy rates in children remain high despite established diagnostic pathways. Variation in imaging strategies, risk stratification, and management decisions may contribute to avoidable surgery. The PAPAYA study evaluated contemporary UK practice to identify factors associated with negative appendicectomy in paediatric patients.
Methods
PAPAYA is a multicentre retrospective cohort study conducted across eighteen UK district general hospitals between August 2020 and August 2024. Children admitted with suspected appendicitis were identified using clinical coding and radiology reports. Data collected included demographics, Paediatric Appendicitis Score (PAS), imaging, management strategy (operative versus conservative), antibiotic use and histological outcomes. Associations between diagnostic variables and histological appendicitis were assessed using Spearman’s rank correlation for ordinal data and chi-square or Fisher’s exact tests for categorical variables. Age differences between management groups were analysed using the Mann–Whitney U test.
Results
A total of 1,091 children were included. The overall negative appendicectomy rate was 21%. Age differed significantly between operative and conservatively managed patients (p=0.0023). PAS demonstrated no correlation with histological appendicitis (Spearman’s ρ=0.004, p=0.951). Ultrasound findings were not associated with histological appendicitis (p=0.336). Among children with non-visualised or equivocal ultrasound findings, 87% proceeded to appendicectomy with normal histology. Antibiotic use on admission was not associated with reduced readmission in conservatively managed patients (p=0.039).
Conclusion
Negative appendicectomy remains common in paediatric practice, with limited diagnostic utility from current risk scores and ultrasound alone. These findings highlight significant variation in diagnostic pathways and support the need for more standardised, evidence-based approaches to reduce avoidable surgery in children.