title: Management of children with possible appendicitis: a survey of emergency physicians in Australia and New Zealand.
abstract: OBJECTIVE
  To describe current practice in managing children with possible acute appendicitis in EDs in Australia and New Zealand as the basis for a clinical practice guideline (CPG).
  
  
  METHODS
  An anonymous survey was distributed to consultant emergency physicians working at PREDICT (Paediatric Research in Emergency Departments International Collaborative) sites in Australia and New Zealand in April 2013. A second, site-based survey was distributed to the PREDICT representatives at each of the 13 sites.
  
  
  RESULTS
  The response rate was 100% (13/13) for the site-based survey and 82% (145/176) for the physician survey. Most respondents agreed that right lower quadrant (RLQ) tenderness (94%), anorexia (92%), migration of abdominal pain to the RLQ (86%), rebound tenderness in the RLQ (60%) and RLQ tenderness produced on coughing, hopping or percussion (63%) were valuable symptoms and signs in diagnosing appendicitis. The responses regarding nausea and vomiting and fever were less consistent. Less than 50% regarded blood tests (C-reactive protein, white cell count) as relevant for the diagnosis of appendicitis. Most physicians (61%) agreed there was a role for a validated CPG for possible appendicitis in children, although only 3/13 sites reported use of such a CPG.
  
  
  CONCLUSIONS
  This survey of senior emergency physicians across Australia and New Zealand demonstrated congruence in several clinical markers and disagreements in others in the approach to diagnosing children with possible appendicitis. Whereas emergency physicians would like a validated CPG, this survey has highlighted some critical issues. Particularly, the low regard for blood tests, integral to published diagnostic scoring systems, will be a challenge for the development and introduction of such a CPG in Australia and New Zealand.
authors.affiliation: Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Kieran
authors.initials: K
authors.lastname: Mc Cabe
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
authors.forename: Sarah
authors.initials: S
authors.lastname: Dalton
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis; D001064:Appendicitis / Q000175:diagnosis*; D001291:Attitude of Health Personnel; D001315:Australia; D015415:Biomarkers / Q000097:blood; D019468:Disease Management; D004636:Emergency Service, Hospital; D019538:Health Care Surveys; D006801:Humans; D009520:New Zealand; D010808:Physical Examination / Q000379:methods; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers
keywords: abdominal pain; appendicitis; clinical practice guideline; paediatric appendicitis score