. 2025 Jun 27:14:e67941.

doi: 10.2196/67941.

Validation and Comparison of Pediatric Appendicitis Scores and Management Strategies (Project SPASMS): Protocol for a Prospective Multicenter Observational Study

Wei Hao Lee^{1

2}, Sharon O'Brien^{2

3

4}, Elizabeth J Mckinnon⁵, Simon Craig^{6

7}, Stuart Dalziel^{8

9}, Michael Collin¹⁰, Natalie Phillips^{11

12}, Franz E Babl^{13

14

15}, Sarah Julia Davidson¹⁶, Shane George^{17

18

19}, Shefali Jani^{20

21}, Doris Tham^{14

15

22}, Viet Tran^{23

24}, Meredith L Borland^{1

2

3}

Affiliations

¹ Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia.
² Emergency Department, Perth Children's Hospital, Nedlands, Australia.
³ Division of Emergency Medicine, School of Medicine, University of Western Australia, Nedlands, Australia.
⁴ Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Australia.
⁵ Biostatistics, The Kids Research Institute Australia, Nedlands, Australia.
⁶ Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia.
⁷ Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Australia.
⁸ Emergency Department, Starship Children's Health, Auckland, New Zealand.
⁹ Department of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
¹⁰ Department of Surgery, Perth Children's Hospital, Nedlands, Australia.
¹¹ Emergency Department, Queensland Children's Hospital, Brisbane, Australia.
¹² Child Health Research Centre, University of Queensland, South Brisbane, Australia.
¹³ Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Australia.
¹⁴ Emergency Department, Royal Children's Hospital, Parkville, Australia.
¹⁵ Emergency Research Group, Murdoch Children's Research Institute, Parkville, Australia.
¹⁶ Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Australia.
¹⁷ Children's Emergency and Critical Care Collaborative Research Group, Gold Coast University Hospital, Gold Coast, Australia.
¹⁸ Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
¹⁹ Faculty of Medicine, University of Queensland, Brisbane, Australia.
²⁰ Department of Emergency Medicine, Children's Hospital at Westmead, Sydney, Australia.
²¹ Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
²² Sunshine Paediatric Emergency Department, Western Health, Melbourne, Australia.
²³ Royal Hobart Hospital, Tasmanian Health Service, Hobart, Australia.
²⁴ Menzies Institute for Medical Research, Tasmanian School of Medicine, University of Tasmania, Hobart, Australia.

PMID: 40577711
PMCID: PMC12254709
DOI: 10.2196/67941

Validation and Comparison of Pediatric Appendicitis Scores and Management Strategies (Project SPASMS): Protocol for a Prospective Multicenter Observational Study

Wei Hao Lee et al. JMIR Res Protoc. 2025.

. 2025 Jun 27:14:e67941.

doi: 10.2196/67941.

Authors

Affiliations

¹ Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia.
² Emergency Department, Perth Children's Hospital, Nedlands, Australia.
³ Division of Emergency Medicine, School of Medicine, University of Western Australia, Nedlands, Australia.
⁴ Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Australia.
⁵ Biostatistics, The Kids Research Institute Australia, Nedlands, Australia.
⁶ Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia.
⁷ Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Australia.
⁸ Emergency Department, Starship Children's Health, Auckland, New Zealand.
⁹ Department of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
¹⁰ Department of Surgery, Perth Children's Hospital, Nedlands, Australia.
¹¹ Emergency Department, Queensland Children's Hospital, Brisbane, Australia.
¹² Child Health Research Centre, University of Queensland, South Brisbane, Australia.
¹³ Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Australia.
¹⁴ Emergency Department, Royal Children's Hospital, Parkville, Australia.
¹⁵ Emergency Research Group, Murdoch Children's Research Institute, Parkville, Australia.
¹⁶ Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Australia.
¹⁷ Children's Emergency and Critical Care Collaborative Research Group, Gold Coast University Hospital, Gold Coast, Australia.
¹⁸ Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
¹⁹ Faculty of Medicine, University of Queensland, Brisbane, Australia.
²⁰ Department of Emergency Medicine, Children's Hospital at Westmead, Sydney, Australia.
²¹ Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
²² Sunshine Paediatric Emergency Department, Western Health, Melbourne, Australia.
²³ Royal Hobart Hospital, Tasmanian Health Service, Hobart, Australia.
²⁴ Menzies Institute for Medical Research, Tasmanian School of Medicine, University of Tasmania, Hobart, Australia.

PMID: 40577711
PMCID: PMC12254709
DOI: 10.2196/67941

Abstract

Background: Abdominal pain is a common reason for children to attend the Emergency Department (ED) with acute appendicitis being the most common surgical cause. Various clinical prediction scores (CPSs) have been developed to assist in determining the risk of appendicitis; however, CPSs have been inadequately validated in children and haphazardly adopted in Australia and New Zealand (ANZ) EDs.

Objective: This study aims to compare and validate various CPSs for diagnosing pediatric appendicitis in children presenting to ANZ EDs.

Methods: This prospective multicenter observational study across 10 ANZ EDs is recruiting children 5-17 years presenting to participating EDs with acute right-sided or generalized abdominal pain lasting ≤7 days and clinician suspicion of appendicitis. CPSs will be calculated by the study team from clinician-recorded data and clinician gestalt recorded on a visual analog scale. Accuracy of CPSs will be assessed by the area under the receiver operating characteristic curve and proportions correctly identified as either low-risk or high-risk based on the CPSs published cutoffs. The final diagnosis of appendicitis will be confirmed on histopathology, and the absence of appendicitis confirmed by telephone, email, or a combination of both to follow up for those discharged directly from ED.

Results: This study received funding in July 2023 and started enrolment in August 2023. As of October 2024, we have enrolled and completed follow-up on 1227 participants with an expected end date in mid-2025.

Conclusions: This study aims to determine the best-performing CPS for diagnosing pediatric appendicitis in ANZ EDs. Implementation of this CPS in ANZ EDs has the potential to reduce health care costs, rationalize the use of health care resources, and improve the management and outcomes of childhood appendicitis.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12622001293752; https://tinyurl.com/242wwenx.

International registered report identifier (irrid): DERR1-10.2196/67941.

Keywords: abdominal pain; appendicitis; clinical prediction scores; emergency medicine; pediatric.

©Wei Hao Lee, Sharon O'Brien, Elizabeth J Mckinnon, Simon Craig, Stuart Dalziel, Michael Collin, Natalie Phillips, Franz E Babl, Sarah Julia Davidson, Shane George, Shefali Jani, Doris Tham, Viet Tran, Meredith L Borland. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 27.06.2025.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared

Figures

**Figure 1**
Study process and timeline. CRF: case report form. *Dependent on consent and need for follow up. **Contact for retrospective consent can be performed concurrently with follow up in 30-60 days.

See this image and copyright information in PMC

References

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Validation and Comparison of Pediatric Appendicitis Scores and Management Strategies (Project SPASMS): Protocol for a Prospective Multicenter Observational Study

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Validation and Comparison of Pediatric Appendicitis Scores and Management Strategies (Project SPASMS): Protocol for a Prospective Multicenter Observational Study

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