For a patient with suspected acute appendicitis, you should arrange emergency hospital admission for specialist assessment and management NICE CKS. This admission is the pathway to surgical evaluation if deemed necessary by the specialists NICE CKS.
You should have a very low threshold for admitting the following patient groups due to increased risk of complications or atypical presentation NICE CKS:
- People with suspected complications NICE CKS. This is because appendiceal perforation is associated with increased morbidity and mortality NICE CKS.
- Pregnant women NICE CKS. Appendicitis can increase the risk of fetal loss and pre-term delivery, and presentation may be atypical NICE CKS.
- Elderly people NICE CKS. They may have atypical presentations and an increased risk of complications like perforation NICE CKS.
- Infants and young children NICE CKS. Diagnosis can be challenging, and presentation may be atypical in this age group NICE CKS.
Prompt diagnosis and treatment are important to reduce the risk of complications, which increases with the duration of symptoms NICE CKS. A delay can increase the risk of perforated appendicitis NICE CKS.
If there is a low index of suspicion of acute appendicitis at initial presentation and immediate hospital admission is not considered necessary, you should consider arranging additional investigations in primary care to exclude alternative conditions NICE CKS. It is also important to advise the person and/or parents of symptoms to be aware of and when to seek urgent medical review NICE CKS.