3 THE CURRENT MANAGEMENT OF RIGHT ILIAC FOSSA PAIN IN CHILDREN - RIFT A MULTICENTRE TRAINEE LEAD COHORT STUDY
RIFT STUDY GROUP
WM Research Collaborative, Birmingham, United Kingdom. PSTRN, Birmingham, United Kingdom

Abstract

Aim:

Children presenting with right iliac fossa (RIF) pain are a common challenge for acute surgical services.  Recent guidelines suggest an appendicectomy should be performed laparoscopically and children <5 years old should be transferred to a specialist children’s hospital (SCH).  There is increased scrutiny of General Paediatric Surgical (GPS) services but little is known regarding the current management of RIF pain across the country.

Methods:

Prospective, multicentre trainee-led cohort study enrolling all patients that presented with RIF pain.


Results:

A total of 11,535 (2041 <16 years old) patients were enrolled across 290 surgical units in the UK, Ireland, Spain, Italy and Portugal. Subset analysis was performed on the 1945 children from the UK&I, 535 treated in a SCH.  A greater number of children <5yrs old were treated in SCH (58 [10.8%] vs 32 [2.2%]) however with similar median ages (10 vs 11).  54 (10%) patients treated at a SCH were transferred from another centre.  Appendicitis risk severity scores were used infrequently (<2%), ultrasound was performed in 39% of patients. 

Non-operative management was commenced in 6.6%.  691 (35%) children with RIF pain had an operation on the index admission, with 68% commenced laparoscopically (72.1% SCH v 66.2%).  There were significantly different operation, approach and negative appendicectomy rates across different genders, ages and between the non-specialist and SCH (Table 1).

Age

Total patients

Appendicectomy rate

Laparoscopic rate

Negative appendicectomy rate

 

Males

Female

Males

Female

 

Males

Female

0-5

87

79

24.1%

36.7%

70.6%

11.8%

10.3%

6-12

577

511

38.1%

31.5%

52.9%

10.9%

16.7%

13-15

221

334

52.0%

26.0%

75.9%

17.1%

25.0%

                 

 




Conclusions:

Appendicitis in children is now managed predominantly laparoscopically across UK&I with an appropriate negative appendicectomy rate.  These may be improved with more judicious investigations and severity scores.  GPS networks will support non-SCH providing this service and increasing laparoscopy rates.

 

 


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