AB173. 101. Retrospective cohort study on paediatric appendicectomies and the use diagnostic ultrasound at University Hospital Limerick

Background: Acute abdominal pain in children remains a common presentation to A&E departments across Ireland. Appendicectomy remains a common procedure done in children. In this study we aimed to analyse the number of paediatric appendicectomies from Aug 2016–Aug 2018 at the University Hospital Limerick (UHL), and the use of imaging in the diagnosis of acute appendicitis.

Methods: Using the Hospital Inpatient Enquiry (HIPE) administrative database, all paediatric patients (≤16 years) who underwent an appendicectomy at UHL from August 2016–August 2018 were identified retrospectively. Data were collected on each patient as follows: imaging and results, surgery (open or laparoscopic appendicectomy) and histology of appendix. Negative appendicectomy rates and ultrasound diagnostic yields were calculated.

Results: From August 2016–August 2018, 474 paediatric patients had an appendicectomy at UHL. Of these, 251 were male (53.0%). A total of 373 patients had histological evidence of appendicitis (78.7%), 55 (11.6%) had evidence of lymphoid hyperplasia, Enterobius and/or fecolith with no inflammation and 46 (9.7%) had a normal appendix. There were 303 (63.9%) laproscopic appendicectomies and 171 (36.1%) open appendicectomies. Only 156 (32.9%) patients had ultrasounds. One hundred and four (66.7%) patient ultrasounds were reported inconclusive for appendicitis. Sixty-four (61.54%) of the patients with an inconclusive ultrasound yield had appendicitis.

Conclusions: Ultrasound remains a poor imaging modality in diagnosing appendicitis. This may contribute to the high negative appendicectomy rates.

Keywords: Appendicitis; paediatric appendicectomy; paediatric surgery; ultrasound