Management of children with possible appendicitis: A survey of emergency physicians in A ustralia and N ew Z ealand

Objectives To describe current practice in managing children with possible acute appendicitis in EDs in A ustralia and N ew Z ealand as the basis for a clinical practice guideline ( CPG ). Methods An anonymous survey was distributed to consultant emergency physicians working at PREDICT (Paediatric Research in Emergency Departments International Collaborative) sites in A ustralia and N ew Z ealand in A pril 2013. A second, site‐based survey was distributed to the PREDICT representatives at each of the 13 sites. Results The response rate was 100% (13/13) for the site‐based survey and 82% (145/176) for the physician survey. Most respondents agreed that right lower quadrant ( RLQ ) tenderness (94%), anorexia (92%), migration of abdominal pain to the RLQ (86%), rebound tenderness in the RLQ (60%) and RLQ tenderness produced on coughing, hopping or percussion (63%) were valuable symptoms and signs in diagnosing appendicitis. The responses regarding nausea and vomiting and fever were less consistent. Less than 50% regarded blood tests (C‐reactive protein, white cell count) as relevant for the diagnosis of appendicitis. Most physicians (61%) agreed there was a role for a validated CPG for possible appendicitis in children, although only 3/13 sites reported use of such a CPG . Conclusions This survey of senior emergency physicians across A ustralia and N ew Z ealand demonstrated congruence in several clinical markers and disagreements in others in the approach to diagnosing children with possible appendicitis. Whereas emergency physicians would like a validated CPG , this survey has highlighted some critical issues. Particularly, the low regard for blood tests, integral to published diagnostic scoring systems, will be a challenge for the development and introduction of such a CPG in A ustralia and N ew Z ealand.