title: How do you diagnose appendicitis? An international evaluation of methods.
abstract: BACKGROUND
  Considerable variability exists in the diagnostic approach to acute appendicitis (in children), affecting both quality and costs of care. Interestingly, an international evaluation of what is commonly practiced today has not been performed. We aimed to document current practice patterns in the diagnosis of appendicitis in children and to determine whether a consensus exists in the workup of these patients among Canadian, Dutch, and Saudi Arabian pediatric surgeons.
  
  
  METHODS
  We performed a cross-sectional survey using a pre-designed, self-administered, 14-item survey. We sent the survey to participants via electronic mail.
  
  
  RESULTS
  In total, 83 responses were received and analyzed, yielding a response rate of 42%. The majority of respondents practiced at pediatric surgery centers with over 50 beds (58% of Canadian surgeons, 81% of Dutch surgeons, 93% of Saudi Arabian surgeons). The majority of Dutch surgeons had a preference for physical examination and radiological imaging as opposed to Canadian and Saudi Arabian surgeons who favored history and physical examination. Interestingly, only one of the surgeons surveyed used an appendicitis scoring system. Regarding history and physical examination, most respondents deemed migratory abdominal pain and localized RLQ tenderness to be most suggestive of appendicitis. Ultrasound was the most preferable imaging modality in acute appendicitis across all three countries.
  
  
  CONCLUSIONS
  This study demonstrates that international pediatric surgeons vary substantially in the diagnostic workup of patients with appendicitis. Furthermore, there is a variability between common practice and the current evidence. We recommend that pediatric surgeons develop clinical practice guidelines that are based on consensus information (expert opinion) and the best available literature.
authors.affiliation: Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Alfraih
authors.affiliation: Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ray
authors.initials: R
authors.lastname: Postuma
authors.affiliation: Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics & Child Health and Manitoba Institute of Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Physiology (Adjunct), University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: richardkeijzer@gmail.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Keijzer
mesh_terms: D000293:Adolescent; D001064:Appendicitis / Q000175:diagnosis*; D002170:Canada; D002648:Child; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D012529:Saudi Arabia; D055815:Young Adult
keywords: Appendicitis; Children; Diagnosis; Workup