• Graham C Thompson, Suzanne Schuh, Jocelyn Gravel, Sarah Reid, Eleanor Fitzpatrick, Troy Turner, Maala Bhatt, Darcy Beer, Geoffrey Blair, Robin Eccles, Sarah Jones, Jennifer Kilgar, Natalia Liston, John Martin, Brent Hagel, Alberto Nettel-Aguirre, and Pediatric Emergency Research Canada.
• Alberta Children's Hospital Research Institute and Department of Pediatrics, University of Calgary, Calgary, AB.
• Acad Emerg Med. 2015 Jul 1;22(7):811-22.

ObjectivesThe objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies.MethodsTwelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with after-hours surgery were determined using generalized estimating equations logistic regression.ResultsOf the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p < 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p < 0.001), blood cultures (p < 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p < 0.001 and p = 0.001, respectively), as did the type of surgical approach (p < 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014).ConclusionsAcross Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes.© 2015 by the Society for Academic Emergency Medicine.

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