False Positive Rate Among Pediatric Appendicitis Patients Transferred to a Tertiary Children’s Hospital

Background: Many patients with suspected appendicitis are initially evaluated at outlying hospitals and then transferred to a tertiary care pediatric hospital for surgical management. We sought to evaluate whether diagnosis prior to transfer provides a reliable basis for direct admission to a pediatric surgery service. Methods: Patients transferred during calendar year 2018 with the principal diagnosis of acute appendicitis were compared based on the service accepting the patient: Emergency Department (ED) or Pediatric Surgery (PS). Data were evaluated using Student’s t-tests. Results: Overall patient characteristics were consistent among ED and PS transfers. The number of patients accepted directly to PS underwent significantly more computed tomography (80.2% vs 54.1%, P =.0002). Despite diagnostic “confirmation” with cross-sectional imaging, 14.7% of patients admitted directly to PS were found to be false positives. Conclusion: A significant proportion of patients referred to pediatric hospitals for appendicitis do not require admission or operation. A protocol which encourages cross-sectional imaging before PS evaluation may subject children to unnecessary radiation and still result in non-surgical admissions. Routine ED transfer allows PS evaluation, targeted imaging, and discharge for non-surgical patients. This approach decreases costs for the families whose children received a false positive diagnosis at a referring facility, while preserving inpatient bed availability.