When does ultrasound influence management in suspected cases of paediatric appendicitis? A retrospective dual centred study between Christchurch public hospital in New Zealand and Royal Aberdeen children's hospital in Scotland

Abstract

s / International Journal of Surgery 10 (2012) S53–S109 S64 ABSTRACTS Conclusion: A large proportion of children underwent surgery which revealed, histologically, a non-inflamed appendix. Discrepancies remain between intra-operative and histological findings, with implications for those arguing for increased use of ‘laparoscopy & proceed' techniques. Poor adherence to hospital antibiotic protocol was noted. 0389: WHEN DOES ULTRASOUND INFLUENCE MANAGEMENT IN SUSPECTED CASES OF PAEDIATRIC APPENDICITIS? A RETROSPECTIVE DUAL CENTRED STUDY BETWEEN CHRISTCHURCH PUBLIC HOSPITAL IN NEW ZEALAND AND ROYAL ABERDEEN CHILDREN'S HOSPITAL IN SCOTLAND Duncan S.G. Scrimgeour , Christopher Driver , Sebastian King , Spencer Beasley . Royal Aberdeen Children's Hospital, Aberdeen, UK; Christchurch Public Hospital, Christchurch, New Zealand Ultrasound (US) is a safe imaging modality used for assessing patients with abdominal pain but its use in the management of acute appendicitis is contentious. Aim: To review the role of US in themanagement of suspected appendicitis in two similarly matched hospitals. Methods: Data from acute admissions, radiology and theatre were crossreferenced to review all children <16 years of age that underwent an appendicectomy an US for query appendicitis in 2009. Results: The number of US scans performed were similar between the two centres (108/442 NZ and 30/157 Aberdeen). Girls were more likely to be scanned than boys (Chi21⁄40.038). The visualisation rate(VR) of the appendix at US was 32% in NZ and 17% in Aberdeen with identical Positive Predictive Value(67%), Negative Predictive Value(100%) and positive appendicectomy rate(73%) in both institutions. Combined, 28%(13/46) had an appendicectomy when the appendix was not seen at US and no other pathology was detected, of which 54% were confirmed cases of appendicitis. Conclusion: We should be encouraging radiologists to look for the appendix. VR is much poorer than literature suggests. If US-negative, have a high threshold for appendicectomy. If US-positive this aids laboratory results and clinical suspicion. What is the role of a diagnostic laparoscopy? 0613: CRYING OUT FOR A DRINK: COMPLIANCE WITH NATIONAL PRE-OPERATIVE FASTING GUIDELINES IN CHILDREN Stephani Bernard, Alexander Macdonald, Jianli Samantha Goh, Niyi AdeAjayi. King's College Hospital, London, UK Aim: Appropriate pre-operative fasting in children is crucial to minimise risk of aspiration. However, over zealous fasting may adversely affect recovery as well as increasing parent and child anxiety. Children admitted for elective surgery are often initially clerked on general paediatric wards by paediatric juniors. This may result in incorrect pre-operative fasting. We set out to audit practice against national guidelines. Method: A questionnaire survey was undertaken of surgeons, paediatricians and nursing staff involved in the care of children (birth to 16yrs) from 5 surgical sub-specialties (general, neurosurgery, OMFS, orthopaedic and transplant) on both general paediatric and sub-specialty specific wards. Statistical analysis for variation with p < 0.05 accepted as significant. Results: 43 individuals were surveyed (19 doctors [8 surgical, 11 paediatric], 24 nurses). 35% had full awareness of fasting guidelines and there was no statistically significant difference between staff groups. Knowledge of specific fasting times for formula and breast milk was poor compared with those for solids and clear fluids (p1⁄40.002). Conclusions: Current awareness of paediatric pre-operative fasting guidelines is poor particularly those regarding formula and breast milk and thus pertaining to younger infants. This is concerning as this group is particularly susceptible to pre-operative distress when fasted incorrectly. 1113: HERNIOTOMY IN CHILDREN – LONG TERM FOLLOW UP Bhavani Sidhartha Mothe, Magdi Hanafy. Leighton General Hospital, Crewe,