How do you diagnose appendicitis? An international evaluation of methods

Area of Science:

• Pediatric Surgery
• Diagnostic Imaging
• Clinical Practice

Background:

• Variability in acute appendicitis diagnosis impacts care quality and costs in children.
• No prior international evaluation of current diagnostic practices for pediatric appendicitis existed.
• Significant practice variations necessitate a review of diagnostic approaches.

Purpose of the Study:

• To document current practice patterns in diagnosing appendicitis in children.
• To assess consensus among Canadian, Dutch, and Saudi Arabian pediatric surgeons regarding diagnostic workup.
• To identify international variations in appendicitis diagnosis.

Main Methods:

• Cross-sectional survey with a 14-item questionnaire.
• Electronic mail distribution of the self-administered survey.
• Analysis of 83 responses from pediatric surgeons.

Main Results:

• Dutch surgeons favored physical examination and radiology, while Canadian and Saudi Arabian surgeons preferred history and physical examination.
• Ultrasound was the preferred imaging modality across all surveyed countries.
• Only one surgeon utilized an appendicitis scoring system.

Conclusions:

• Substantial international variation exists in the diagnostic workup of pediatric appendicitis.
• Current common practices diverge from available evidence.
• Development of evidence-based clinical practice guidelines is recommended.