Evidence map›Paper›PMID 42596001›Full record

ReviewDiagnostic and prognostic research2026

Impact of a diagnostic strategy for appendicitis in children with acute abdominal pain in primary care: study protocol for a hybrid type 1 cluster randomised controlled trial.

Esmee M Hogervorst, Roderick P Venekamp, Grietje E Knol-de Vries, Tamara N Platteel, Roeland M Watjer, Daan P Hurkmans, Mattijs E Numans, Guus C G H Blok, Eline J A Q Naber, Michiel R de Boer and 16 more

Registry-linked trialAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Diagnostic and prognostic research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06762275 (Optimizing Management of Children Presenting With Acute Abdominal Pain in Primary Care), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06762275 narecruitingnot on this map

Optimizing Management of Children Presenting With Acute Abdominal Pain in Primary Care: a Cluster Randomized Controlled Trial Evaluating the Impact of a Clinical Prediction Rule Including C-reactive Protein for Appendicitis

TypeinterventionalSponsorUniversity Medical Center GroningenRan2025 to 2029Enrolled566ConditionsAppendicitis Acute, Acute Abdomen in ChildrenArmsDiagnostic strategy
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

26 authors.

Esmee M HogervorstDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
Roderick P VenekampDepartment of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Grietje E Knol-de VriesDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
Tamara N PlatteelDepartment of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Roeland M WatjerDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Daan P HurkmansDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Mattijs E NumansDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Guus C G H BlokDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
Eline J A Q NaberDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
Michiel R de BoerDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
Karin M VermeulenDepartment of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.
Meefa HogenesExpertDoc B.V, Leiden, The Netherlands.
Eric HiddinkDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
P Chris TrompHealth Base, Houten, the Netherlands.
Ramon R GorterDepartment of Surgery, Division of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Albert HolvastDepartment of Pediatrics, Martini Hospital Groningen, Groningen, The Netherlands.
Jan B F HulscherDepartment of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Chantal M C R Everts-PanmanDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
Gera A WelkerUniversity Medical Center Staff Policy and Management Support, University Medical Center Groningen, Groningen, The Netherlands.
Sven J G GeelenDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
Arne R M van der BiltDepartment of Surgery, Ommelander Hospital Groningen, Scheemda, The Netherlands.
Elyne DeuringDepartment of Emergency Medicine, University Medical Center Groningen, Groningen, the Netherlands.
Marjolein Y BergerDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
Esen DoganerStichting Kind & Zorg, Utrecht, The Netherlands.
Huibert BurgerDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
Gea A HoltmanDepartment of Primary- and Long-term Care, Cure and Care in the Community Context (FOUR-C Research program), FA21, University of Groningen, University Medical Centre Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands. g.a.holtman@umcg.nl.

Funding

ZonMw 10390022210064
6 · The paper itself

Abstract

backgroundChildren with acute abdominal pain pose a diagnostic challenge for general practitioners (GPs), as it can be difficult to distinguish appendicitis from self-limiting conditions due to overlapping symptoms. To support GPs, a diagnostic strategy for appendicitis was developed that integrates an externally validated prediction rule with C-reactive protein point-of-care testing (CRP POCT) and risk-based management advice. This study will compare the impact of this diagnostic strategy to usual care in children with acute abdominal pain in primary care in terms of: (i) clinical effectiveness, (ii) cost-effectiveness, and (iii) implementation potential.

methodsWe will conduct a pragmatic, hybrid type 1 effectiveness-implementation, cluster randomised controlled trial in Dutch general practice. Children aged 4-18 years with acute (≤ 7 days) abdominal pain will be included. GP practices will be randomly allocated to either: (i) use of the diagnostic strategy for appendicitis, or (ii) usual care. In the intervention group, children are stratified into low, medium, or high risk for appendicitis based on a seven-item prediction rule including symptoms and signs. Management advice is tailored to appendicitis risk: safety netting for low-risk, immediate referral for high-risk, or CRP POCT for medium-risk (CRP < 10 mg/L: safety netting; CRP 10-50 mg/L: reassessment or immediate referral (based on GPs' clinical judgement and parent/child preference); CRP ≥ 50 mg/L: immediate referral). The primary outcome is referral efficiency (proportion of non-referrals amongst patients with no appendicitis during 30 days follow-up). Secondary outcomes include safety, proportion of children with CRP POCT, proportion of children with planned reassessment, child anxiety, patient satisfaction, quality of life, and costs. A parallel process evaluation will assess implementation outcomes, including the reach, adoption, implementation, and maintenance of the diagnostic strategy. We aim to include 566 children without appendicitis to determine an improvement of efficiency from 88% to 95%. DISCUSSION: We hypothesise that use of the diagnostic strategy will reduce referrals without increasing delayed diagnoses of appendicitis, compared to usual care in children presenting with acute abdominal pain in primary care. This may ultimately result in better patient outcomes, lower costs, and reduced health care resource use.

trial registrationClinicalTrials.gov: NCT06762275 (registration date: 2024/12/03).

Indexed as

AppendicitisChildrenClinical prediction ruleC-reactive proteinPrimary care

Identifiers

PMID42596001
PMCPMC13474870

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.