Thousands of children undergo unnecessary appendicectomy each year in the NHS, suggest the findings of a new study published in The Lancet Child & Adolescent Health.
The study reviewed data from 1827 children aged 5-15 years presenting to one of the 139 centres across the UK and Ireland with acute right iliac fossa pain. Approximately, a third (34.5%) of the children underwent appendicectomy.
The normal appendicectomy rate across the entire cohort was 15.9 per cent (100 of 630 patients). The rate was highest in girls aged 11-15 years (22.4%).
The overall normal appendicectomy rate in the UK and Ireland is one of the highest in the world. Rates of 3-5 per cent are typical in the USA and the Netherlands, where a greater proportion of children undergo computed tomography imaging.
The authors say increasing imaging rates is likely to be a cost-effective means of reducing unnecessary surgery, based on an average cost of paediatric appendicectomy around £3700.
Of 15 risk prediction models reviewed in the study, the Shera score was the best performing model, with an area under the curve of 0.84 (95% CI, 0.82-0.86).
To support calculation and application of appropriate Shera score cut-offs at the patient bedside, the Right Iliac Fossa Treatment Study collaborative has developed an app to predict risk for children presenting with acute right iliac fossa pain. The app is available here.