WTP7.9 Optimising Appropriate Referral, Early Diagnosis and Management of Patients Presenting to the Emergency Department with Right Iliac Fossa Pain; a Collaborative Approach in The Design of Local Right Iliac Fossa Pain Pathway

Abstract

Abstract Diagnostic uncertainty in patients presenting with right iliac fossa (RIF) pain to the Emergency Department (ED) is well established and multifactorial, leading to challenges in selecting the most appropriate specialty for initial referral. This study investigates local practice, which will form the basis for RIF pain pathway development. Methods We collected prospective data over one month for RIF pain presentations to our ED, with onward referral to General Surgery (December 2022 – January 2023). This included demographics, symptoms, appendicitis likelihood utilising validated scoring tools, investigations, management and final histology. The number of women undergoing gynaecological review was also assessed, as were negative laparoscopy rates. Results Data collection revealed 46 patients presented with RIF pain: 30(65%) female, median age 29(18-44), 16(35%) male median age 35(21-53.) Thirteen (28%) underwent diagnostic laparoscopy, two of which were negative, one male and one female. Ultrasound scan (USS) was conducted in 70% females, and 6% males; CT in 31% males, and 27% females. Gynaecology review & USS were conducted in 38% of women. Overall, 87% of women had imaging. Two women underwent a laparoscopy without imaging. Acute appendicitis was diagnosed definitively in 21%. Conclusions The majority of patients in this study were premenopausal women. This cohort poses a diagnostic challenge. Further data is required, with collection underway, to help understand the best way to manage these patients. The outcomes of our data collection highlight the need for a local right iliac fossa pathway to improve appropriate specialty referral, timely imaging, diagnostic certainty and avoidance of negative laparoscopy.