Hundreds of children are having needless operations to remove their appendix ever year, researchers have warned.
One in six children who underwent surgery for appendicitis actually had a healthy organ removed, according to a study of hospitals across Britain and Ireland.
Surgery for appendicitis is the most common emergency operation in children, with 10,000 children undergoing the procedure every year in Britain.
But according to the new study many of these operations are not needed – up to 1,600 a year, according to the researchers led by University of Birmingham.
They believe children are being misdiagnosed because doctors are not properly interpreting the ultrasound scans used to examine them.
Hundreds of children in the UK are having needless operations to remove their appendix ever year, researchers have warned (stock image)
The scientists tested the extracted organs of 1,827 children after they underwent appendicectomies at 139 different hospitals.
The tests – published today in the Lancet Child & Adolescent Health journal – showed 16 per cent of the children had never had appendicitis in the first place.
Researcher Aneel Bhangu, senior lecturer in surgery at the University of Birmingham, said: ‘Appendicectomy is the most common emergency operation in children.
‘Our study found that overall the diagnosis is wrong for one in six children who undergo appendicectomy, and a normal appendix is removed.
‘This places an unacceptable burden on both children and their carers.’
The children tested were aged between five and 15.
Overall, only around a third of children admitted to hospital with suspected appendicitis actually underwent an appendicectomy.
Of those who had the operation at the age of five to ten, 12 per cent had unnecessary operations.
WHAT IS APPENDICITIS?
Appendicitis is a swelling of the appendix, a two to four-inch-long organ connected to the large intestine.
Appendicitis can cause severe pain and it’s important for it to be treated swiftly in case the appendix bursts, which can cause life-threatening illness.
In most cases surgeons will remove the appendix in an appendectomy – scientists aren’t sure why people need an appendix but removing it does not harm people.
The causes of appendicitis aren’t clear but it is thought to be caused by something blocking the entrance to the organ.
Symptoms include pain in the stomach which later travels to your lower right-hand-side and becomes severe.
Pressing on this area, coughing, or walking can all make the pain worse, and other symptoms can be nausea, vomiting, loss of appetite, diarrhoea and a fever.
Of boys aged 11 to 15, 16 per cent of the operations were needless.
And for girls aged 11 to 15, 22 per cent were not needed.
They called of urgent improvements in ultrasound scan analysis to avoid more needless operations.
They said all children with suspected appendicitis should be given a routine ‘risk score’ to rule out the problem, and then the remainder should be given an ultrasound by someone trained specifically in spotting appendicitis.
If an ultrasound is inconclusive, doctors should consider carrying out a CT scan as a second-line diagnostic tool, although they admitted this exposes children to radiation.
Dr Dmitri Nepogodiev, one of the study leaders, said: ‘Obviously CT is not ideal in children due to the radiation exposure – albeit this exposure is relatively low- so we would only suggest this in the small group of patients with uncertain diagnosis after ultrasound.
‘MRI is an excellent alternative – very accurate, with no radiation – but it is unlikely that most hospitals will be able to offer MRI in the emergency setting.’
In time, he said, MRI scans may replace CT scans, but at the moment the NHS does not have enough machines.
Regardless, with each child appendicectomy costing about £3,700, avoiding needless surgery could save the NHS £4.4million a year and spare hundreds of children from the knife.
Dr Nepogodiev, added: ‘It’s important that children receive the right diagnosis before a decision is made to operate.
‘Ultrasound scans have the advantage that unlike CT scans they do not expose children to radiation.
‘They have been found to be an effective diagnostic tool in other countries, but we found that in the UK ultrasound is frequently inconclusive.
‘Hospitals should ensure seven-day-a-week availability of ultrasound done by staff specially trained to assess for acute appendicitis in children.’
A similar study published by the same team last year found the problem is even worse among adults.
They found that for 20 per cent of adults who underwent appendicectomies the organ had been completely healthy – resulting in 5,500 needless operations among adults each year.