798 Improving the Use of Ultrasound Imaging in the Diagnosis and Assessment of Paediatric Patients Admitted with Suspected Appendicitis

Abstract

Abstract Aim To investigate the barriers to and rate of ultrasonography use to facilitate the diagnosis of suspected appendicitis and assess its effect on negative appendicectomy rates in concordance with GIRFT guidelines for children with abdominal pain. Method Retrospective single-site data on paediatric patients presenting with suspected appendicitis was collected over 6 months, using operative and admission records, imaging requests and histology results. An anonymous survey was distributed amongst Surgical clinicians to determine the perceived impact of access to and influencers of ultrasonography use for children. Results Of 91 patients, 35 underwent a diagnostic laparoscopy. The operation findings were: 23% (8) not acute appendicitis, 23% (8) perforated or complex appendicitis and 54% (19) “other” acute appendicitis. 85% (30) of patients who were surgically managed did not have an ultrasound before theatre. 23% (21) of the total cohort underwent an ultrasound and none of the scans suggested acute appendicitis. Of these, 76% (16) of patients were managed non-operatively. Of the 5 patients who underwent an ultrasound and proceeded to laparoscopy; none had intraoperative findings of appendicitis. Further analysis aims to investigate why ultrasound was utilised for only 23% of patients and to clarify the decision-making processes behind a “straight to theatre” versus an “imaging-first” approach. Conclusions The negative paediatric appendicectomy rate in this District General Hospital was 23%. According to this data, ultrasonography is a reliable rule-out tool for suspected appendicitis and more frequent use could reduce unnecessary operations.