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Accuracy of inter-hospital paediatric appendicitis referrals

Authors

  • Paxton Loke,

    1. Department of Paediatric Surgery, Monash Children's, Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia
    2. Department of Emergency Medicine, Monash Children's, Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia
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    • Paxton Loke, MBBS, Resident; Joselito Tantoco, MD, Senior Registrar; Peter Ferguson, FRACS, Consultant Paediatric Surgeon; Yves Heloury, FRACS, Consultant Paediatric Surgeon; Chris Kimber, FRACS, Consultant Paediatric Surgeon; Ed Oakley, FACEM, Director of Paediatric Emergency and Adjunct Associate Professor; Wei Cheng, PhD, Chair and Professor of Paediatric Surgery.
  • Joselito Tantoco,

    1. Department of Paediatric Surgery, Monash Children's, Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia
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    • Paxton Loke, MBBS, Resident; Joselito Tantoco, MD, Senior Registrar; Peter Ferguson, FRACS, Consultant Paediatric Surgeon; Yves Heloury, FRACS, Consultant Paediatric Surgeon; Chris Kimber, FRACS, Consultant Paediatric Surgeon; Ed Oakley, FACEM, Director of Paediatric Emergency and Adjunct Associate Professor; Wei Cheng, PhD, Chair and Professor of Paediatric Surgery.
  • Peter Ferguson,

    1. Department of Paediatric Surgery, Monash Children's, Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia
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    • Paxton Loke, MBBS, Resident; Joselito Tantoco, MD, Senior Registrar; Peter Ferguson, FRACS, Consultant Paediatric Surgeon; Yves Heloury, FRACS, Consultant Paediatric Surgeon; Chris Kimber, FRACS, Consultant Paediatric Surgeon; Ed Oakley, FACEM, Director of Paediatric Emergency and Adjunct Associate Professor; Wei Cheng, PhD, Chair and Professor of Paediatric Surgery.
  • Yves Heloury,

    1. Department of Paediatric Surgery, Monash Children's, Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia
    2. Department of Pediatrics, Department of Surgery, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
    Search for more papers by this author
    • Paxton Loke, MBBS, Resident; Joselito Tantoco, MD, Senior Registrar; Peter Ferguson, FRACS, Consultant Paediatric Surgeon; Yves Heloury, FRACS, Consultant Paediatric Surgeon; Chris Kimber, FRACS, Consultant Paediatric Surgeon; Ed Oakley, FACEM, Director of Paediatric Emergency and Adjunct Associate Professor; Wei Cheng, PhD, Chair and Professor of Paediatric Surgery.
  • Chris Kimber,

    1. Department of Paediatric Surgery, Monash Children's, Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia
    Search for more papers by this author
    • Paxton Loke, MBBS, Resident; Joselito Tantoco, MD, Senior Registrar; Peter Ferguson, FRACS, Consultant Paediatric Surgeon; Yves Heloury, FRACS, Consultant Paediatric Surgeon; Chris Kimber, FRACS, Consultant Paediatric Surgeon; Ed Oakley, FACEM, Director of Paediatric Emergency and Adjunct Associate Professor; Wei Cheng, PhD, Chair and Professor of Paediatric Surgery.
  • Ed Oakley,

    1. Department of Emergency Medicine, Monash Children's, Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia
    2. Department of Pediatrics, Department of Surgery, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
    3. Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
    Search for more papers by this author
    • Paxton Loke, MBBS, Resident; Joselito Tantoco, MD, Senior Registrar; Peter Ferguson, FRACS, Consultant Paediatric Surgeon; Yves Heloury, FRACS, Consultant Paediatric Surgeon; Chris Kimber, FRACS, Consultant Paediatric Surgeon; Ed Oakley, FACEM, Director of Paediatric Emergency and Adjunct Associate Professor; Wei Cheng, PhD, Chair and Professor of Paediatric Surgery.
  • Wei Cheng

    Corresponding author
    1. Department of Pediatrics, Department of Surgery, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
    • Department of Paediatric Surgery, Monash Children's, Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia
    Search for more papers by this author
    • Paxton Loke, MBBS, Resident; Joselito Tantoco, MD, Senior Registrar; Peter Ferguson, FRACS, Consultant Paediatric Surgeon; Yves Heloury, FRACS, Consultant Paediatric Surgeon; Chris Kimber, FRACS, Consultant Paediatric Surgeon; Ed Oakley, FACEM, Director of Paediatric Emergency and Adjunct Associate Professor; Wei Cheng, PhD, Chair and Professor of Paediatric Surgery.

Correspondence: Professor Wei Cheng, Department of Paediatric Surgery, Monash Children's, Level 5, Block E, 246 Clayton Road, Clayton, Vic. 3168, Australia. Email: wei.cheng@monash.edu

Abstract

Objective

Appendicitis is the most common paediatric surgical emergency. In our institution, the majority of inter-hospital transfers are for suspected appendicitis. We undertook an audit to assess the accuracy of the provisional diagnosis of the transferred cases.

Methods

Retrospective electronic data of a tertiary referral centre and a single referring regional hospital were collected between January 2009 and December 2010. Primary outcome of surgery, inpatient observation or discharge was assessed. The final appendix pathology results were examined.

Results

There were 187 paediatric surgical transfers (49% by ambulance) that were provisionally diagnosed as appendicitis. Of the 187 patients (M : F = 102 : 85, a median age of 11), 70% were admitted, 43% underwent appendicectomy, and only 40% had pathologically proven appendicitis.

Conclusions

Of the surgical referrals for appendicectomy, 60% did not have appendicitis. An improved assessment protocol is required to reduce the margin of diagnostic error and transfer cost, while maintaining clinical safety.

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