GIRFT guidance supports better care pathways for children with abdominal pain to reduce unnecessary surgery

Guidance to further drive a national reduction in the number of children having their appendix removed unnecessarily and ensure consistent standards of care is now available to NHS teams in England.

A cross-specialty group of 35 clinicians – drawn from specialist and non-specialist centres, and including nurses with interests in pain, surgery, community care and discharge planning – have worked with the Getting It Right First Time (GIRFT) programme to agree the guidance, alongside a best practice pathway for diagnosing and treating children with all forms of acute abdominal pain, including appendicitis.

The guidance and pathway are now available to download on GIRFT’s FutureNHS pages here and in the GIRFT Academy Best Practice Library.

They follow GIRFT’s national specialty report for paediatric general surgery and urology (September 2021), which showed that more than 10% of children in England who had an appendicectomy were having a healthy appendix removed, compared with a rate of 2.5% or lower in the US and other European countries.

The report outlined a series of actions for improving the diagnosis and treatment of acute abdominal pain in children, including a specific recommendation for the development of a model appendicectomy pathway.

Use of the newly developed pathway will now build on the positive progress seen since the GIRFT team visited 89 specialist and high-volume trusts providing children’s surgical care in 2018, prior to drafting the national report.

Appendicectomy is one of the most common operations for young patients in England, with around 10,000 procedures in the NHS every year.

Since GIRFT first highlighted variations in the care of children with acute abdominal pain to trust teams, and outlined measure to help, the number of young patients having a normal appendix removed (negative appendicectomy) has almost halved, from 11.5% to 5.8%, meaning around 500 children per year now avoid unnecessary surgery. At the same time, the percentage of children undergoing less-invasive laparoscopic (keyhole) appendicectomy has increased from 55% to 79%.

Professor Simon Kenny, NHS England’s national clinical director for children and young people and the GIRFT clinical lead for paediatric general surgery and urology, said:

“On my GIRFT deep dive visits in 2018, we noted huge variation in all aspects of the management of children with abdominal pain – from how they are assessed and treated in paediatric emergency departments through to aspects of post-operative care. We also saw the adverse impact this can have on outcomes for children.

“Abdominal pain is a ubiquitous feature of childhood, so recognition of serious conditions can be challenging. This pathway represents a consensus view from clinicians of all specialties on how we can ensure the best care for children, aligned with the algorithms used by the 111 service to reduce inconsistency in early decisions.

“I sincerely hope it will go some way to significantly improving the quality of care on offer for the children and families we care for, no matter where they live.”

Paediatric acute abdominal pain and appendicectomy: Best practice pathway guidance is available to all healthcare professionals involved in the care of children with acute abdominal pain and appendicectomy, as well as local and national commissioners, service improvement leads, operational delivery networks (ODNs), Integrated Care Systems (ICS) children and young person leads, and others involved in ensuring an efficient and effective approach to delivering high quality services for children across England.

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