When should I consider referring a patient with suspected appendicitis for surgical evaluation?

For a patient with suspected acute appendicitis, you should arrange emergency hospital admission for specialist assessment and management ¹. This admission is the pathway to surgical evaluation if deemed necessary by the specialists ¹.

You should have a very low threshold for admitting the following patient groups due to increased risk of complications or atypical presentation ¹:

• People with suspected complications ¹. This is because appendiceal perforation is associated with increased morbidity and mortality ¹.
• Pregnant women ¹. Appendicitis can increase the risk of fetal loss and pre-term delivery, and presentation may be atypical ¹.
• Elderly people ¹. They may have atypical presentations and an increased risk of complications like perforation ¹.
• Infants and young children ¹. Diagnosis can be challenging, and presentation may be atypical in this age group ¹.

Prompt diagnosis and treatment are important to reduce the risk of complications, which increases with the duration of symptoms ¹. A delay can increase the risk of perforated appendicitis ¹.

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 ¹. It is also important to advise the person and/or parents of symptoms to be aware of and when to seek urgent medical review ¹.