Accuracy of inter-hospital paediatric appendicitis referrals

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.

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.

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.

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.