Suspected Pediatric Appendicitis Management in the Emergency Department: A Prospective Observational Study in an Australian Pediatric Emergency Department

Wei Hao Lee; Sharon O'Brien; Elizabeth J Mckinnon; Simon Craig; Stuart Dalziel; Meredith L Borland

doi:10.1097/PEC.0000000000003544

Suspected Pediatric Appendicitis Management in the Emergency Department: A Prospective Observational Study in an Australian Pediatric Emergency Department

Pediatr Emerg Care. 2026 Mar 1;42(3):209-217. doi: 10.1097/PEC.0000000000003544. Epub 2026 Jan 12.

Authors

Wei Hao Lee^{1

2

3}, Sharon O'Brien^{3

4

5}, Elizabeth J Mckinnon⁶, Simon Craig^{7

8}, Stuart Dalziel^{9

10}, Meredith L Borland^{2

3

4}

Affiliations

¹ Department of General Paediatrics, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch.
² Division of Paediatrics, School of Medicine, University of Western Australia, Crawley.
³ Emergency Department, Perth Children's Hospital.
⁴ Division of Emergency Medicine, School of Medicine, University of Western Australia, Nedlands.
⁵ Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth.
⁶ Biostatistics, The Kids Research Institute Australia, Nedlands.
⁷ Paediatric Emergency Department, Monash Medical Centre, Monash Health.
⁸ Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Australia.
⁹ Emergency Department, Starship Children's Health.
¹⁰ Department of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.

Abstract

Objective: Abdominal pain is a common pediatric presentation in the emergency department (ED), and acute appendicitis (AA) is the most common surgical diagnosis. This study describes the management of suspected AA in a tertiary Australian pediatric ED.

Methods: A single-center prospective observational study was performed between November 2022 and May 2023. Children aged 5 to 15 years presenting to the ED with acute abdominal pain and clinician suspicion of AA were included. Clinical gestalt was measured using a 5-point Likert Scale before and after blood tests. Diagnosis of AA was confirmed on histopathology, and non-AA was confirmed with follow-up at 30 to 60 days.

Results: The study enrolled 481 children; AA was diagnosed in 146 (30.6%). Patients with AA were older (11.1 vs. 10.0 y) and more likely to be male (69.2% vs. 48.1%) compared with those without AA. Blood tests were performed in 449 (93.3%) children, with higher rates in AA cases (100% vs. 90.4%). Gestalt improved with blood test results, with overall diagnostic accuracy increasing from 65.9% pre-blood tests to 88.5% post-blood tests. Ultrasound (US) was performed in 361 (75.1%) children with a diagnostic accuracy of 90.6% and was frequently used even in patients deemed low-risk post-blood tests (65.7%). One hundred and fifty (31.2%) of suspected AA cases underwent surgery, with 3 negative appendectomies and 1 ovarian cystectomy without appendectomy. Median (IQR) hospital length of stay was significantly longer for AA cases than non-AA cases [50.8 (35.3 to 95.0) h vs. 7.1 (4.6 to 16.8) h].

Conclusions: This study reviews the management and outcomes of suspected AA in a high-volume Australian ED. It shows the importance of blood tests in improving diagnostic accuracy of clinician gestalt and highlights the potential overuse of US in low-risk patients. Future research should explore a more structured diagnostic approach to increase diagnostic accuracy, optimize resource utilization, and improve patient outcomes.

Keywords: appendicitis; clinician gestalt; diagnostic accuracy; ultrasound.

Publication types

Observational Study

MeSH terms

Abdominal Pain / etiology
Adolescent
Appendectomy / statistics & numerical data
Appendicitis* / diagnosis
Appendicitis* / surgery
Appendicitis* / therapy
Australia
Child
Child, Preschool
Emergency Service, Hospital* / statistics & numerical data
Female
Humans
Male
Prospective Studies
Ultrasonography / statistics & numerical data