Optimizing Management of Children Presenting With Acute Abdominal Pain in Primary Care Using Clinical Prediction Rule and C-reactive Protein Testing for Appendicitis

What this Trial Is About

Researchers are studying children aged 4 to 18 years who visit their general practitioner with acute abdominal pain to evaluate a new diagnostic strategy for acute appendicitis (AA). This strategy combines a clinical prediction rule (cPR) based on seven signs and symptoms with a C-reactive protein point-of-care test (CRP POCT) for those at medium risk. The study aims to improve referral efficiency by reducing unnecessary referrals while ensuring children with AA receive timely care. This is a cluster randomized controlled trial comparing this diagnostic approach with usual care in primary care settings. In this trial, general practitioners in the intervention group will apply the cPR and selectively use the CRP POCT for children classified as medium risk. The cPR score guides whether children are given safety advice, referred immediately, or tested with CRP POCT to decide further action. The control group will provide standard care according to Dutch guidelines, which rely on symptoms and signs without CRP testing. The study will recruit children over two years from different GP practices to compare the outcomes of these approaches. Participants will be followed for 30 days to assess referral efficiency, safety, and other outcomes such as anxiety, satisfaction, quality of life, and healthcare costs. Data will be collected on the use of CRP POCT, planned reassessments, and complications. Questionnaires and health assessments will be used to monitor children's well-being and parental satisfaction. The study includes a process evaluation to understand how the diagnostic strategy is used and its impact on care, with follow-up extending to three months for some measures.

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