What is important to the GP in recognizing acute appendicitis in children: a delphi study

Area of Science:

• Medical Research
• Clinical Practice
• Diagnostic Studies

Background:

• Diagnostic research for appendicitis requires understanding how general practitioners (GPs) generate medical records.
• A consensus was sought on essential features GPs use during consultations and in medical records for children with suspected appendicitis.

Approach:

• A three-round Delphi study was conducted with Dutch GPs.
• An initial list of features was derived from literature and Dutch guidelines.
• A vignette and online questionnaire assessed features for consultation and recording.

Key Points:

• Consensus was reached on 26 symptoms, 29 physical assessments, 2 tests, and 8 actions, including safety-netting.
• GPs agreed 37 features should be actively addressed and 20 recorded if negative.
• Negative findings are often not recorded, while prognostic and safety-netting advice should be documented.

Conclusions:

• Research implications: negative findings are likely missing from records.
• Medicolegal implications: complete documentation cannot be assumed.
• Clinical practice implications: safety-netting advice is crucial and should be documented.