Evaluating Paediatric Surgery Consultations: Insights From a Tertiary Emergency Department

AIM: Paediatric surgical consultations constitute an important component of paediatric emergency department (PED) practice, yet detailed data on referral patterns and clinical outcomes remain limited. This study aimed to evaluate the characteristics, urgency, timing and clinical outcomes of paediatric surgery consultations in a tertiary PED and to identify potential areas for improving referral processes and resource utilization. METHODS: This retrospective, single-centre, cross-sectional study included paediatric surgery consultations requested from the PED between January 1 and December 31, 2022. Consultations were classified as emergency, urgent, or elective and emergency referral indications were further categorized according to the suspected diagnosis or primary clinical concern at referral. Clinical outcomes were classified as discharge, hospitalization without surgery, or hospitalization with surgery. Consultation timing (working hours vs. after-hours) and seasonal trends were also analysed. Statistical analysis was conducted using SPSS v25, with p < 0.05 considered significant. RESULTS: A total of 5433 consultations were analysed; 86.3% were classified as emergency, 9.8% as urgent and 3.8% as elective. Among emergency consultations, trauma and burns (n = 1369) and suspected appendicitis (n = 1100) were the most frequent indications. Of patients referred with suspected appendicitis, 51.2% were discharged and 26.2% underwent surgery, whereas 76.7% of those with acute abdominal pain without a specific surgical diagnosis were discharged and none underwent surgery. Overall, 65.3% of patients were discharged and 16.2% underwent surgery. Most consultations (70.4%) occurred after-hours; however, neither urgency distribution (p = 0.133) nor clinical outcomes (p = 0.124) differed significantly according to consultation timing. CONCLUSIONS: Paediatric surgery consultations encompassed a heterogeneous spectrum of conditions with substantially different clinical outcomes. Diagnosis-specific analysis identified potential opportunities for institution-specific refinement of referral and triage pathways. Although most consultations occurred after hours, their urgency and clinical outcomes did not differ significantly from those during working hours. Given the single-centre design and institution-dependent nature of referral practices, these findings should be interpreted within the context of the study setting.