JMIR Publications

ABSTRACT

Background:

Abdominal pain is a common reason for children to attend the Emergency Department (ED) with acute appendicitis being the most common surgical cause. Various clinical prediction scores (CPSs) have been developed to assist in determining the risk of appendicitis; however, CPSs have been inadequately validated in children and haphazardly adopted in Australia and New Zealand (ANZ) EDs.

Objective:

This study aims to compare and validate various CPSs for diagnosing paediatric appendicitis in children presenting to ANZ EDs.

Methods:

This prospective multicentre observational study across ten ANZ EDs is recruiting children 5-17 years presenting to participating EDs with acute right-sided or generalised abdominal pain ≤7 days and clinician suspicion of appendicitis. CPSs will be calculated by the study team from clinician-recorded data and clinician gestalt recorded on a visual analogue scale. Accuracy of CPSs will be assessed by Area Under the Receiver Operative Characteristic Curve and proportions correctly identified as either low-risk or high-risk based on the CPSs published cut-offs. Final diagnosis of appendicitis will be confirmed on histopathology, and the absence of appendicitis confirmed by telephone/email follow-up for those discharged directly from ED.

Results:

This study received funding in July 2023 and started enrolment in August 2023. As of October 2024, we enrolled and completed follow up on 1227 participants with an expected end date in mid-2025.

Conclusions:

This study aims to determine the best performing CPS for diagnosing pediatric appendicitis in ANZ EDs. Implementation of this CPS in ANZ EDs has the potential to reduce healthcare costs, rationalise the use of healthcare resources, and improve management and outcomes of childhood appendicitis. Clinical Trial: Australian New Zealand Clinical Trials Registry (ACTRN12622001293752): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12622001293752