Transfer practices and outcomes for suspected appendicitis from community hospitals to a paediatric tertiary emergency department

Background Children with suspected appendicitis are often transferred from community emergency departments (EDs) across the Greater Toronto Area (GTA) to a Toronto paediatric tertiary-care ED due to inconsistent access to, and experience with, paediatric ultrasound, surgery, and anaesthesia. Literature on transfer practices and outcomes is sparse. Objective To investigate transfer patterns and outcomes in children with suspected appendicitis transferred from community EDs to a paediatric tertiary ED. Methods A retrospective chart review was conducted for children with suspected appendicitis transferred from 19 GTA community EDs to a Toronto paediatric tertiary-care ED from October 1, 2021, to September 30, 2022. Primary outcome was the proportion of children with appendicitis. Secondary outcomes included rates of ultrasound repetition and surgical consultation post-transfer. All transferred children were included; descriptive statistics were performed. Results Of the 282 children (mean age 7 years, 60% male), 164 (58%) were diagnosed with appendicitis, while 118 (42%) children were discharged without. Among those without appendicitis, 100 (85%) had a community ultrasound; 77 (77%) were read as positive for appendicitis, and 89 (89%) of the community-imaged patients had repeat ultrasound after transfer. Among the 164 children diagnosed with appendicitis, 144 (88%) had a community ultrasound, with 78 (54%) undergoing repeat ultrasound after transfer. Surgical consultation in the paediatric ED occurred for all children with appendicitis and for 26/118 (22%) of those without. Conclusions Nearly half of the children transferred for suspected appendicitis were discharged without appendicitis, and most community ultrasounds required re-imaging. Opportunities exist to optimize transfer pathways and ultrasound resources.