Evaluating a Clinical Prediction Rule and CRP Test to Improve Diagnosis of Acute Appendicitis in Children With Abdominal Pain in Primary Care

What this Trial Is About

Researchers are evaluating a diagnostic strategy to improve the identification of acute appendicitis AA in children aged 4 to 18 years who visit their general practitioner GP with acute abdominal pain. Early-stage AA is challenging to distinguish from other common causes like constipation or gastroenteritis. This study compares a clinical prediction rule cPR combined with a C-reactive protein point-of-care test CRP POCT to usual care to see if it improves referral efficiency without delaying diagnosis. The study involves two groups one where GPs use the diagnostic strategy consisting of a cPR based on seven clinical signs and symptoms, followed by CRP POCT for medium-risk children and a control group where GPs provide care as usual following national guidelines without CRP testing. The cPR score guides decisions, with low-risk children receiving safety advice, high-risk children referred immediately, and medium-risk children receiving CRP testing to decide on referral or reassessment. The diagnostic strategy is integrated electronically for GPs to use during consultations. Participants will be monitored over 30 days for referral efficiency and safety, with additional assessments at 3 months for anxiety, satisfaction, quality of life, and costs. Researchers will collect data on CRP testing use, planned reassessments, and clinical outcomes. The study uses a cluster randomized design involving multiple GP practices and includes a process evaluation of implementation. The primary outcome is the proportion of appropriate referrals, aiming to reduce unnecessary referrals while ensuring timely care for children with AA.

The Impact of a Diagnostic Strategy for Acute Appendicitis in Children With Acute Abdominal Pain in Primary Care