title: Accuracy of inter-hospital paediatric appendicitis referrals.
abstract: OBJECTIVE
  Appendicitis is the most common paediatric surgical emergency. In our institution, the majority of inter-hospital transfers are for suspected appendicitis. We undertook an audit to assess the accuracy of the provisional diagnosis of the transferred cases.
  
  
  METHODS
  Retrospective electronic data of a tertiary referral centre and a single referring regional hospital were collected between January 2009 and December 2010. Primary outcome of surgery, inpatient observation or discharge was assessed. The final appendix pathology results were examined.
  
  
  RESULTS
  There were 187 paediatric surgical transfers (49% by ambulance) that were provisionally diagnosed as appendicitis. Of the 187 patients (M : F = 102 : 85, a median age of 11), 70% were admitted, 43% underwent appendicectomy, and only 40% had pathologically proven appendicitis.
  
  
  CONCLUSIONS
  Of the surgical referrals for appendicectomy, 60% did not have appendicitis. An improved assessment protocol is required to reduce the margin of diagnostic error and transfer cost, while maintaining clinical safety.
authors.affiliation: Department of Paediatric Surgery, Monash Children's, Monash Medical Centre/Southern Health, 246 Clayton Road, Clayton, VIC 3168, Australia.
authors.forename: Paxton
authors.initials: P
authors.lastname: Loke
authors.forename: Joselito
authors.initials: J
authors.lastname: Tantoco
authors.forename: Peter
authors.initials: P
authors.lastname: Ferguson
authors.forename: Yves
authors.initials: Y
authors.lastname: Heloury
authors.forename: Chris
authors.initials: C
authors.lastname: Kimber
authors.forename: Ed
authors.initials: E
authors.lastname: Oakley
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
mesh_terms: D001064:Appendicitis / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies