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This research examines the management and diagnostic processes for suspected pediatric appendicitis in the emergency department.

January 14, 2026Open Access

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Suspected Pediatric Appendicitis Management in the Emergency Department

WLWei Hao LeeThe University of Western Australia SOSharon O'BrienThe University of Western Australia EME. McKinnonThe Kids Research Institute Australia

Key Points

This research examines the management and diagnostic processes for suspected pediatric appendicitis in the emergency department.
Single-center prospective observational study conducted in a pediatric emergency department.
Included children aged 5 to 15 presenting with acute abdominal pain suspected of being acute appendicitis.
Clinical gestalt assessed using a 5-point Likert Scale before and after blood tests.
Histopathology confirmed diagnosis of acute appendicitis, with follow-up at 30 to 60 days.
481 children enrolled, with acute appendicitis diagnosed in 146 (30.6%).
Patients with acute appendicitis were older and more likely to be male compared to non-appendicitis cases.
Blood tests performed in 449 (93.3%) children, with diagnostic accuracy improving from 65.9% to 88.5% post-tests.
Ultrasound performed in 361 (75.1%) children, with a 90.6% diagnostic accuracy.
Median hospital length of stay was significantly longer for acute appendicitis cases than non-appendicitis cases.

Abstract

Objective: Abdominal pain is a common pediatric presentation in the emergency department (ED), and acute appendicitis (AA) is the most common surgical diagnosis. This study describes the management of suspected AA in a tertiary Australian pediatric ED. Methods: A single-center prospective observational study was performed between November 2022 and May 2023. Children aged 5 to 15 years presenting to the ED with acute abdominal pain and clinician suspicion of AA were included. Clinical gestalt was measured using a 5-point Likert Scale before and after blood tests. Diagnosis of AA was confirmed on histopathology, and non-AA was confirmed with follow-up at 30 to 60 days. Results: The study enrolled 481 children; AA was diagnosed in 146 (30.6%). Patients with AA were older (11.1 vs. 10.0 y) and more likely to be male (69.2% vs. 48.1%) compared with those without AA. Blood tests were performed in 449 (93.3%) children, with higher rates in AA cases (100% vs. 90.4%). Gestalt improved with blood test results, with overall diagnostic accuracy increasing from 65.9% pre-blood tests to 88.5% post-blood tests. Ultrasound (US) was performed in 361 (75.1%) children with a diagnostic accuracy of 90.6% and was frequently used even in patients deemed low-risk post-blood tests (65.7%). One hundred and fifty (31.2%) of suspected AA cases underwent surgery, with 3 negative appendectomies and 1 ovarian cystectomy without appendectomy. Median (IQR) hospital length of stay was significantly longer for AA cases than non-AA cases 50.8 (35.3 to 95.0) h vs. 7.1 (4.6 to 16.8) h. Conclusions: This study reviews the management and outcomes of suspected AA in a high-volume Australian ED. It shows the importance of blood tests in improving diagnostic accuracy of clinician gestalt and highlights the potential overuse of US in low-risk patients. Future research should explore a more structured diagnostic approach to increase diagnostic accuracy, optimize resource utilization, and improve patient outcomes.

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Suspected Pediatric Appendicitis Management in the Emergency Department

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