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.