Validation and Comparison of Pediatric Appendicitis Scores and Management Strategies (Project SPASMS): Protocol for a
Wei Hao Lee1,2, Sharon O'Brien2,3,4, Elizabeth J Mckinnon5
1Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia.
Insights
This study validates clinical prediction scores (CPSs) for diagnosing appendicitis in children across Australian and New Zealand emergency departments (EDs). Findings will help select the best CPS to improve pediatric appendicitis diagnosis and management.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Support
- Surgical Diagnostics
Background:
- Abdominal pain is a frequent pediatric emergency department (ED) complaint, with acute appendicitis as the most common surgical etiology.
- Clinical prediction scores (CPSs) exist to aid appendicitis diagnosis, but their validation and adoption in Australian and New Zealand (ANZ) EDs are inconsistent.
Purpose of the Study:
- To prospectively compare and validate various CPSs for diagnosing pediatric appendicitis in children presenting to ANZ EDs.
- To identify the most accurate CPS for improving diagnostic efficiency and patient outcomes.
Main Methods:
- Prospective, multicenter observational study in 10 ANZ EDs involving children aged 5-17 with suspected appendicitis.
- CPSs calculated from clinician data and gestalt; accuracy assessed via ROC curves and risk stratification.
- Appendicitis confirmed by histopathology; non-appendicitis cases confirmed via follow-up.
Main Results:
- Study funded July 2023, enrollment began August 2023.
- As of October 2024, 1227 participants enrolled with completed follow-up.
- Study expected completion in mid-2025.
Conclusions:
- This research will identify the optimal CPS for diagnosing pediatric appendicitis in ANZ EDs.
- Implementing the best CPS can potentially reduce healthcare costs, optimize resource allocation, and enhance the management of childhood appendicitis.
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 pediatric appendicitis in children presenting to ANZ EDs.
Methods:
This prospective multicenter observational study across 10 ANZ EDs is recruiting children 5-17 years presenting to participating EDs with acute right-sided or generalized abdominal pain lasting ≤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 analog scale. Accuracy of CPSs will be assessed by the area under the receiver operating characteristic curve and proportions correctly identified as either low-risk or high-risk based on the CPSs published cutoffs. The final diagnosis of appendicitis will be confirmed on histopathology, and the absence of appendicitis confirmed by telephone, email, or a combination of both to 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 have 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 health care costs, rationalize the use of health care resources, and improve the management and outcomes of childhood appendicitis.
Trial Registration:
Australian New Zealand Clinical Trials Registry ACTRN12622001293752; https://tinyurl.com/242wwenx.
International Registered Report Identifier (Irrid):
DERR1-10.2196/67941.
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