Background Diagnostic accuracy of ultrasound for adults is stated as excellent. Paediatric and adult acute scrotal diseases are different. Findings in adults may not apply in children. The authors have seen overconfidence and interpretation with adult disease in mind in children with scrotal pain and have seen testicular loss as a result. Objectives To interrogate the literature methodologically to report diagnostic accuracy of ultrasound (US) for the acute scrotum specifically in CYP with a follow-up methodology which allows identification of missed torsion. Study design We performed systematic review and meta-analysis of studies reporting true diagnostic accuracy of ultrasound for testicular torsion (TT). PubMed, MEDLINE, Scopus, and Web of Science databases were searched from platform start until September 2023 using MeSH terms with protocol as detailed on PROSPERO. Multiple author search was undertaken. Two authors extracted data for included studies. Study quality was reported through QUADAS-2 methodology. Surgical findings or 12 months follow up in non-operative cases would be the gold standard to identify late atrophy due to missed torsion. Studies with methodology to identify missed torsion outwith the initial consult were included for meta-analysis. Results A total of 6790 cases were reported from the 38 papers identified. Studies were often flawed with poor definition of outcomes and short follow-up duration. Meta-analysis of the 10 high-quality studies revealed pooled sensitivity and specificity of 0.93 and 0.99. Doppler US by trained individuals demonstrated excellent diagnostic accuracy. Nonetheless, on extrapolation of the data, especially where flow was preserved, 5.6% of torsions were missed. Discussion/conclusion Our review confirms a high diagnostic accuracy of US for TT in CYP. However, a 5.6% missed torsion rate was found if flow alone was considered diagnostic. The authors suggest US should be used as an adjunct in ambiguous cases, ensuring that clinically obvious torsion goes to theatre immediately and is not delayed by ultrasound. Trial registration PROSPERO: CRD42023412619.

BACKGROUND: Fluorescence-guided surgery (FGS) with Indocyanine Green (ICG) dye enhances intra-operative visualisation of anatomical structures, tissue perfusion, and lymphatic drainage. To inform future practice and collaborative research, we aim to determine current FGS use in paediatric surgical centres in the UK and Ireland (UK&I). METHODS: In November 2023, an online survey of 11 to 21 questions was disseminated to one consultant surgeon at each of the 27 UK&I paediatric surgical centres. RESULTS: Twenty-four of 27 centres (88.9%) responded. Fourteen centres (58.3%) never used FGS, with 7 lacking the appropriate camera. The 10 centres (41.7%) with experience reported recent, limited use, with half performing their first case less than 1 year ago; half used fluorescence on fewer than 5 occasions. The top three indications were oncological procedures, lymphatic assessment, and biliary tree visualisation. A range of ICG doses were reported. Half of the centres had no ICG protocol. Only one centre used FGS in premature neonates. 19/24 (79.2%) deemed FGS helpful or acknowledged future potential; 13/24 (54.2%) believe an FGS registry would be valuable. CONCLUSIONS: Current use of FGS in children is limited and non-standardised. An FGS collaborative interest group or UK&I registry could support experience-sharing and standardisation.

OBJECTIVES:To perform a systematic review to determine the effect of the duration of pain on early and late testicular survival after testicular torsion, and on the performance of diagnostic adjuncts for torsion, including the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score and ultrasonography (US) performance, to inform the development of the 'Getting it Right First Time' (GIRFT) national testicular pain pathway for children and young people (CYP). METHODS:The study was registered on the International Prospective Register of Online Systematic Reviews (CRD42023412619) and four databases were searched. Study inclusion criteria: all participants aged <25 years or where data for these patients could be extracted; studies including <20% neonates and <20% of undescended testes. The decision for inclusion in the study was made independently by two reviewers and conflicts resolved by a third. A weighted random-effects model was used for meta-analysis and results are shown as the test statistic (95% CI). RESULTS:Included studies were used to analyse the effect of duration of pain on testicular salvage (studies = 26), on the sensitivity and specificity of the TWIST score (studies = 10), and of US (studies = 34). The TWIST score performs best in its extremes, with a sensitivity of 94.2% (95% CI 72.8-99%) and specificity 98% (95% CI 91.5-99.5%), when comparing a high-risk score of 5-7 with a low-risk score of 0-2. The diagnostic sensitivity and specificity of US for testicular torsion has likely improved with time, with papers published after 2010 showing a sensitivity of 94.8% (95% CI 88.3-97.8%) and specificity 97.3% (95% CI 89.4-99.4%) compared to all-time published studies showing a sensitivity 92.6% (95% CI 87.8-95.6%) and specificity of 97.8% (95% CI 94.7-99.1%). CONCLUSIONS:These findings demonstrate the up-to-date literature on the effect of duration of pain on salvage of torted testes and on the performance of TWIST scores and US when evaluating CYP with testicular pain. They have been used within the development of the GIRFT testicular pain pathway.

AIMS:To examine if SARS-CoV-2 infection is associated with new-onset type 1 diabetes in the post-acute period in children and young people (CYP). METHODS:In this population cohort, we used data on all hospital activity in England to estimate type 1 diabetes incidence among CYP aged 0-17 exposed to SARS-CoV-2 between May 2020 and August 2022, from day 28 after a positive test for the following 6 months. We compared this with unexposed CYP who were hospitalized for elective procedures or following trauma during the pandemic, and in the 2 years prior to the pandemic (historic cohorts). We excluded CYP with prior chronic illnesses. We undertook Cox regression analyses adjusted for age, sex, ethnicity, deprivation and season of index date, and stratified by periods when different SARS-CoV-2 variants were dominant. RESULTS:There were 1,087,604 CYP in the exposed cohort, 143,748 in the trauma cohort, 253,368 in the elective cohort, 160,925 in the historic trauma cohort and 388,673 in the historic elective cohort. Hazard of developing type 1 diabetes was significantly higher among those exposed than unexposed CYP: 2.4 [1.58-3.64] relative to the trauma cohort, 2.9 [2.00-4.13] relative to the elective cohort, 4.2 [2.56-7.04] relative to the historic trauma cohort and 2.4 [1.81-3.10] relative to the historic elective cohort. Associations may be strongest during the Delta period. CONCLUSIONS:SARS-CoV-2 infection is associated with subsequent incident type 1 diabetes in the 1-7 months after an acute infection in previously healthy CYP.

OBJECTIVES:i) to explore experiences of boys and parents/guardians regarding surgical treatment options for lichen sclerosus et atrophicus (LS/BXO); ii) to gather surgeons' perspectives to inform design of a randomized controlled trial (RCT) comparing preputioplasty with intralesional steroids (PIT) versus circumcision to treat LS. PATIENTS AND METHODS:Semi-structured qualitative interviews conducted with 20 boys (aged 8-18 years) and their families who had previously undergone PIT (n = 15) or circumcision (n = 6). Focus groups/interviews were held with 17 surgeons. Participants were recruited from a regional children's hospital and professional networks. Data were analysed thematically. RESULTS:Patients and families commonly misunderstood foreskin function and surgical options. Delayed symptom recognition and limited awareness of PIT were frequent. Families weighed up immediate versus long-term outcomes when making treatment decisions: some chose circumcision, perceiving it as a definitive resolution, others preferred PIT for foreskin preservation. Boys opted for PIT due to aesthetic concerns, families were concerned about long-term impacts of circumcision. Surgeons supported offering PIT but emphasised the need for RCTs to confirm its effectiveness. Satisfaction was high in both patient groups. Boys, families, and surgeons identified factors they considered important outcomes, which they believed should be measured in future evaluations of both treatments. CONCLUSION:This study highlights the importance of offering the option to retain the foreskin during surgical treatment for LS. It emphasises the need for clinicians to understand patient preferences and calls for better education on normal foreskin anatomy and surgical options, as well as further research into PIT through a RCT.

OBJECTIVE:To investigate SARS-CoV-2 vaccine uptake and effectiveness in children and young people (CYP) with life-limiting neurodisability. DESIGN:We undertook a retrospective cohort study using national hospital data in England from 21 December 2020 to 2 September 2022 to describe SARS-CoV-2 vaccination uptake, and then examined COVID-19 hospitalisation, paediatric intensive care unit (PICU) admission and death following SARS-CoV-2 infection by vaccination status using Cox regression models. PATIENTS:CYP aged 5-17 with life-limiting neurodisability. RESULTS:We identified 38 067 CYP with life-limiting neurodisability; 13 311 (35.0%) received at least one SARS-CoV-2 vaccine, with uptake higher among older, white CYP, from less deprived neighbourhoods. Of 8134 CYP followed up after a positive SARS-CoV-2 test, 1547 (19%) were vaccinated. Within 28 days of infection, 309 (4.7%) unvaccinated CYP were hospitalised with COVID-19 compared with 75 (4.8%) vaccinated CYP. 46 (0.7%) unvaccinated CYP were admitted to PICU compared with 10 (0.6%) vaccinated CYP. 20 CYP died within 28 days of SARS-CoV-2 infection, of which 13 were unvaccinated. Overall, adjusted hazard of hospitalisation for COVID-19 or admission to PICU did not vary by vaccination status. When the Alpha-Delta SARS-CoV-2 variants were dominant, hazard of hospitalisation with COVID-19 was significantly lower among vaccinated CYP (HR 0.26 (0.09 to 0.74)), with no difference seen during Omicron (HR 1.16 (0.74 to 1.81)). CONCLUSIONS:SARS-CoV-2 vaccination was protective of COVID-19 hospitalisation among CYP with life-limiting neurodisability during Alpha-Delta, but not for other SARS-CoV-2 variants. Vaccine uptake was low and varied by ethnicity and deprivation.

BACKGROUND:COVID-19 caused widespread disruptions to health services worldwide, including reductions in elective surgery. Tooth extractions are among the most common reasons for elective surgery among children and young people (CYP). It is unclear how COVID-19 affected elective dental surgeries in hospitals over multiple pandemic waves at a national level. METHODS:Elective dental tooth extraction admissions were selected using Hospital Episode Statistics. Admission trends for the first 14 pandemic months were compared with the previous five years and results were stratified by age (under-11s, 11-16s, 17-24s). RESULTS:The most socioeconomically deprived CYP comprised the largest proportion of elective dental tooth extraction admissions. In April 2020, admissions dropped by >95%. In absolute terms, the biggest reduction was in April (11-16s: -1339 admissions, 95% CI -1411 to -1267; 17-24s: -1600, -1678 to -1521) and May 2020 (under-11s: -2857, -2962 to -2752). Admissions differed by socioeconomic deprivation for the under-11s (P < 0.0001), driven by fewer admissions than expected by the most deprived and more by the most affluent during the pandemic. CONCLUSION:Elective tooth extractions dropped most in April 2020, remaining below pre-pandemic levels throughout the study. Despite being the most likely to be admitted, the most deprived under-11s had the largest reductions in admissions relative to other groups.

Introduction Data on the use of fibrin sealants to control intraoperative bleeding in children are scarce. Evicel Fibrin Sealant (Ethicon Inc., Raritan, New Jersey, United States) was found safe and effective in clinical trials of adults undergoing various surgery types. We evaluated the safety and efficacy of Evicel versus Surgicel Absorbable Hemostat (Ethicon Inc.) as adjunctive topical hemostats for mild/moderate raw-surface bleeding in pediatric surgery. Methods A phase III randomized clinical trial was designed as required by the European Medicines Agency's Evicel Pediatric Investigation Plan: 40 pediatric subjects undergoing abdominal, retroperitoneal, pelvic, or thoracic surgery were randomized to Evicel or Surgicel, to treat intraoperative mild-to-moderate bleeding. Descriptive analyses included time-to-hemostasis and rates of treatment success (4, 7, 10 minutes), intraoperative treatment failure, rebleeding, and thromboembolic events. Results Forty of 130 screened subjects aged 0.9 to 17 years were randomized 1:1 to Evicel or Surgicel. Surgeries were predominantly open abdominal procedures. The median bleeding area was 4.0 cm (2) for Evicel and 1.0 cm (2) for Surgicel. The median time-to-hemostasis was 4.0 minutes for both groups. The 4-, 7-, and 10-minute treatment success rates were 80.0% versus 65.0%, 100.0% versus 80.0%, and 95.0% versus 90.0%, whereas treatment failure rates were 5.0% versus 25.0%, for Evicel and Surgicel, respectively. No deaths or thrombotic events occurred. Re-bleeding occurred in 5.0% of Evicel and 10.0% of Surgicel subjects. Conclusions In accordance with adult clinical trials, this randomized study supports the safety and efficacy of Evicel for controlling mild-to-moderate surgical bleeding in a broad range of pediatric surgical procedures.

Abdominal pain is a common experience during childhood and frequently presents to secondary healthcare facilities. Although non-specific abdominal pain and appendicitis are the most common causes, the clinician should also be aware of the diagnosis and management of all causes of abdominal pain in children. This article provides an overview of abdominal pain in children, including history and examination, initial management, diagnostic categories, modes of investigation, and definitive treatment.

Objectives Delays in elective surgery can impact children and young people's (CYP) social and emotional development,1 2 and prolonged pain from postponed dental treatment can impact CYP's sleep and school attendance.3 Little is known about how COVID-19 impacted elective admissions for dental tooth extractions for CYP, and how this may differ by age and socioeconomic deprivation. Methods All elective dental tooth extractions by the under-25s were extracted from England's Hospital Episode Statistics and stratified into age groups (under-11s, 11–16s, and 17- 24s). Extractions in the under-11s were mostly due to tooth decay, while extractions in the 11–16s and 17–24s were likely due to tooth impactions or as part of orthodontic treatment. The study period was February 2020 to March 2021 and the preceding five pre-pandemic years. The month-by-month percentage drop and absolute difference between periods were reported. Pearson's chi-squared with standardised residuals tested differences between overall periods. Results Figure 1 shows the percentage drop in admissions was steepest in April 2020 for all age groups, with the differences ranging from 94.0% to 97.2% for the under-11s, more than 98% for the 11–16s and 97.9% to over 98.0% for the 17–24s across the socioeconomic deprivation quintiles. Table 1 shows how, in absolute terms, the sum of admission reductions for the pandemic period by deprivation quintile was largest among the most deprived CYP across all age groups, with the under-11s worst affected. When comparing deprivation between periods overall, the admission reductions for the under-11s were statistically significant (p<0.0001). The following standardised residuals showed how this is driven by more than expected admissions by CYP from the least and second least deprived quintiles, and fewer than expected admissions by CYP from the most deprived socioeconomic quintile during the pandemic. Conclusion Among the under-11s, there were significant changes in admissions by socioeconomic deprivation quintile, driven by more than expected admissions by the two most affluent deprivation quintiles and fewer than expected admissions by the most deprived CYP during the pandemic. Children from the most deprived backgrounds, must not be further disadvantaged by the impacts of tooth pain, and need to be prioritised and planned for when addressing backlogs. References Forner D, Leslie PK, Aldaihani A, Bezuhly M, Noel CW, Horne D, et al. Psychosocial distress in parents with children awaiting surgery during the COVID-19 pandemic. Children 2022. Levine RS. Childhood caries and hospital admissions in England: a reflection on preventive strategies. Br Dent J 2021. Goodwin M, Sanders C, Davies G, Walsh T, Pretty IA. Issues arising following a referral and subsequent wait for extraction under general anaesthetic: impact on children. BMC Oral Health 2015.

Background: Little is known about how COVID-19 impacted acute surgical activity for children and young people (CYP) across England. Appendicitis and testicular torsion are common surgical conditions where treatment delays can lead to avoidable complications. We undertook a retrospective national cohort study. Primary aim: To describe monthly acute surgical activity in CYP during the COVID-19 pandemic. Secondary aim: To investigate evidence of delayed diagnosis and adverse outcomes, describing variations by age and socioeconomic deprivation. Methods: Acute hospital admissions with appendicitis or testicular pain for those under 18 were extracted using Hospital Episode Statistics. Interrupted time series modelling, Mann-Whitney and Pearson's Chi-Squared tests compared the first 14 pandemic months with the previous five years. Results were stratified by age (0-4s, 5-9s and 10-17s) and appendicitis type (all, simple and complex). Results: Admissions for appendicitis and testicular torsion fell significantly early in the COVID-19 pandemic. The proportion of children with complex appendicitis also increased during this time. Orchidectomy rates rose in April 2020 for the 0-4s (+15.6% (95% CI 7.9-23.3)) and 10-17s (+11.5% (4.9-18.2)), but when the pre-pandemic period was compared with the pandemic period as a whole, there were no overall statistically significant differences in orchidectomy rates between the study periods. Overall, there was a statistically significant rise in the orchidopexy rate during the pandemic period for the 10-17s when compared with the pre-pandemic period (Pre-pandemic: 17.0% vs Pandemic: 20.9%, p < 0.0001). Conclusion: A consistent reduction in activity, with short-lived periods of delayed presentations during COVID-19 pandemic peaks, occurred without persisting overall increased complication rates. These results provide useful national context for smaller sized studies that reported complications due to delays in surgery. Future research could examine how reduced activity impacted other healthcare settings and treatment pathways. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license(http://creativecommons.org/licenses/by/4.0/).

ObjectivesDevelop a score summarising how successfully a child with any surgical condition has been treated, and test the clinical validity of the score.DesignDiscrete choice experiment (DCE), and secondary analysis of data from six UK-wide prospective cohort studies.Participants253 people with lived experience of childhood surgical conditions, 114 health professionals caring for children with surgical conditions and 753 members of the general population completed the DCE. Data from 1383 children with surgical conditions were used in the secondary analysis.Main outcome measuresNormalised importance value of attribute (NIVA) for number/type of operations, hospital-treated infections, quality of life and duration of survival (reference attribute).ResultsQuality of life and duration of survival were the most important attributes in deciding whether a child had been successfully treated. Parents, carers and previously treated adults placed equal weight on both attributes (NIVA=0.996; 0.798 to 1.194). Healthcare professionals placed more weight on quality of life (NIVA=1.469; 0.950 to 1.987). The general population placed more weight on survival (NIVA=0.823; 95% CI 0.708 to 0.938). The resulting score (the Children's Surgery Outcome Reporting (CSOR) Treatment Success Score (TSS)) has the best possible value of 1, a value of 0 describes palliation and values less than 0 describe outcomes worse than palliation. CSOR TSSs varied clinically appropriately for infants whose data were included in the UK-wide cohort studies.ConclusionsThe CSOR TSS summarises how successfully children with surgical conditions have been treated, and can therefore be used to compare hospitals' observed and expected outcomes.

Objective To describe the COVID-19 pandemic’s impact on acute appendicitis management on children and young people (CYP). Design Retrospective cohort study. Setting All English National Health Service hospitals. Patients Acute appendicitis admissions (all, simple, complex) by CYP (under-5s, 5–9s, 10–24s). Exposure Study pandemic period: February 2020–March 2021. Comparator pre-pandemic period: February 2015–January 2020. Main outcome measures Monthly appendicectomy and laparoscopic appendicectomy rate trends and absolute differences between pandemic month and the pre-pandemic average. Proportions of appendicitis admissions comprising complex appendicitis by hospital with or without specialist paediatric centres were compared. Results 101 462 acute appendicitis admissions were analysed. Appendicectomy rates fell most in April 2020 for the 5–9s (−18.4% (95% CI −26.8% to −10.0%)) and 10–24s (−28.4% (−38.9% to −18.0%)), driven by reductions in appendicectomies for simple appendicitis. This was equivalent to −54 procedures (−68.4 to −39.6) and −512 (−555.9 to −467.3) for the 5–9s and 10–24s, respectively. Laparoscopic appendicectomies fell in April 2020 for the 5–9s (−15.5% (−23.2% to −7.8%)) and 10–24s (−44.8% (−57.9% to −31.6%) across all types, which was equivalent to −43 (−56.1 to 30.3) and −643 (−692.5 to −593.1) procedures for the 5–9s and 10–24s, respectively. A larger proportion of complex appendicitis admissions were treated within trusts with specialist paediatric centres during the pandemic. Conclusions For CYP across English hospitals, a sharp recovery followed a steep reduction in appendicectomy rates in April 2020, due to concerns with COVID-19 transmission. This builds on smaller-sized studies reporting the immediate short-term impacts.

This study focuses on ischaemia-reperfusion injury (IRI) in kidneys, a cause of acute kidney injury (AKI) and end-stage kidney disease (ESKD). Traditional kidney damage assessment methods are semi-quantitative and subjective. This study aims to use a convolutional neural network (CNN) to segment murine kidney structures after IRI, quantify damage via CNN-generated pathological measurements, and compare this to conventional scoring. The CNN was able to accurately segment the different pathological classes, such as Intratubular casts and Tubular necrosis, with an F1 score of over 0.75. Some classes, such as Glomeruli and Proximal tubules, had even higher statistical values with F1 scores over 0.90. The scoring generated based on the segmentation approach statistically correlated with the semiquantitative assessment (Spearman's rank correlation coefficient=0.94). The heatmap approach localised the intratubular necrosis mainly in the outer stripe of the outer medulla, while the tubular casts were also present in more superficial or deeper portions of the cortex and medullary areas. This study presents a CNN model capable of segmenting multiple classes of interest, including acute IRI-specific pathological changes, in a whole mouse kidney section and can provide insights into the distribution of pathological classes within the whole mouse kidney section.

Objective Little is known at national level about how COVID-19 impacted acute surgical activity among children and young (CYP) people. This study investigated procedures for appendicitis and testicular torsion during the pandemic period – two common conditions where delays in treatment can result in preventable complications. Methods Acute appendicitis and testicular pain admissions by 0–24s were extracted using England’s Hospital Episode Statistics. Time-series modelling, Mann-Whitney and Pearson’s Chi-squared test was used to compare the first 14-months of the pandemic cohort (February 2020 to March 2021) with the previous five-year pre-pandemic cohort. We report monthly trends in total admissions and admissions by deprivation quintile. We test for differences in median length of stay (LOS), 28-day readmission rates, orchidopexy and orchidectomy rates between pandemic periods. Results were stratified into age groups (0–4s, 5–9s and 10–24s) and appendicitis type (all, simple and complex). Results Figure 1 shows that admissions for appendicitis fell significantly in the early months of the pandemic. A similar pattern was observed for testicular torsion admissions. The absolute number of complex appendicitis admissions remained relatively stable, but the proportion of complex appendicitis rose early in the pandemic months. Among children aged 5–9, there was a significant reduction in the proportion of appendicitis admissions living in the most deprived quintile of households (Pre-pandemic:25.6% vs Pandemic: 22.7%, p=0.0012). There were statistically significant reductions in median LOS for appendicitis, but this was of limited clinical effect. Of those who had appendicectomies, only the 5–9s had significant reduction in 28-day total readmission rates (Pre-pandemic: 11.7% vs Pandemic: 9.1%, p=0.0002). Among the appendicitis admissions treated non-operatively, only the 10–24s had significantly higher 28-day readmission rates (Pre-pandemic: 18.1% vs Pandemic: 24.4%, p=0.0260). Figure 2 demonstrates that for those admitted for testicular torsion, orchidectomy rates rose in April 2020 for the 5–9s (+15.6% (7.9 to 23.3)) and 10–24s (+5.4% (0.9 to 10.0), but overall orchidectomy rates did not significantly change. Orchidopexy rates rose in the pandemic for the 10–24s (Pre-pandemic: 19.3% vs Pandemic: 23.2%, p<0.0001). Conclusion We found a consistent reduction in acute surgical activity among CYP, with evidence of short-term periods of delayed presentations during pandemic peaks, without persisting overall increased complication rates. These results provide important national context to smaller sized studies reporting complications due to delays in surgery. Future research could examine how reduced activity impacted other healthcare settings and treatment pathways.

BACKGROUND:Non-operative management (NOM) of simple appendicitis is becoming an increasingly researched treatment option. This systematic review aims to describe the short and long-term failure rates of NOM and the complication rate of appendicectomy in children with simple appendicitis. METHODS:The systematic review was registered a priori (CRD42022322149). Study inclusion criteria are: participants aged ≤ 18 years of age; groups undergoing both NOM and appendicectomy for simple appendicitis; outcomes including one or more of: NOM failure rate at 30 days or 1 year and beyond; study design: RCT or case control study. Four databases were searched and 3 reviewers determined study eligibility and data extraction. Risk of bias was assessed and meta-analysis was performed using Stata. RESULTS:The database search identified 2731 articles, 14 studies met the inclusion criteria; 4 RCTs and 10 case controlled studies. All studies had moderate-serious risk of bias. There were no deaths in either group in any study. Meta-analysis demonstrated a 30 day failure rate of 20 % (95 % CI 11-29 %) and 11 studies reported failure rate at 1 year or beyond at 32 % (95 % CI 25-38 %). Rates of significant complications of appendicectomy was 1 % (95 % CI 0-1 %). CONCLUSIONS:Non-operative management of simple appendicitis in children is safe, with moderate early success. The failure rate increases over time, resulting in eventual appendicectomy in a third of the children diagnosed with appendicitis. These data will enable clinicians to have an informed discussion with children and their parents about their treatment options for simple appendicitis. LEVEL OF EVIDENCE:II.

Objectives NHS England has piloted the introduction of paediatric clinicians working in NHS111 clinical assessment service (CAS) to improve the emergency care pathway. This has been shown to increase self-care rates and reduce referrals to other services.1 The aim of this research was to understand the impact of introducing paediatric clinicians into NHS111 on caller experience. This is important when evaluating change to service delivery. Better experiences are associated with better patient outcomes; safer care; and better workforce experience.2 3 Methods An online survey of callers who contacted NHS111 on behalf of a child was conducted. Between February 2022 and October 2022, eligible callers were sent a survey invite from IC24 (an NHS111 host provider for the paediatric CAS) via SMS seven days following their call. To evaluate the impact of the Paediatric Clinical Assessment Service (PCAS) on callers’ experiences, survey responses were compared to a control group – i.e. those who contacted NHS111 on behalf of a child, but their call was managed within non-paediatric CAS. The control cohort was aligned with the symptom groups managed in PCAS: skin complaint or rash; a cough; a head, facial or neck injury; abdominal pain and unwell children aged under one. Data collection is ongoing. Although the size of the control group was small as many calls are managed in PCAS, statistical analyses were able to identify significant differences between groups. Results Between February-October 2022, 1,247 people responded, representing a 7% response rate. Across all nine experience-based questions, those respondents who had spoken to a paediatric clinician rated the experience of their 111 call significantly better compared to those respondents whose call was managed in non-paediatric CAS. Table 1 shows that the question areas with the biggest discrepancy in responses between PCAS and CAS respondents were around the helpfulness of the advice given (71% vs 26%), caller involvement in decisions (70% vs 35%) and their inclination to use the helpline service again (76% vs 42%). Conclusion Respondents who spoke with a paediatric clinician reported a significantly better experience of NHS111 than those whose spoke with a non-paediatric clinician. A national urgent and emergency care plan published in January 2023 set out a commitment to increase access to paediatric advice through NHS111. This research provides further evidence on the value of a specialist paediatric CAS for a more positive caller experience, more efficient service utilisation, and improved patient outcomes. References Stilwell PA, Stuttard G, Scott-Jupp R, et al. Paediatric NHS 111 Clinical Assessment Services pilot: an observational study. Archives of Disease in Childhood 2022;107:e14. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013;3:e001570. Doi:10.1136/bmjopen-2012-001570 Anhang Price R, Elliott MN, Zaslavsky AM, et al. Examining the role of patient experience surveys in measuring health care quality. Medical Care Research and Review 2014;71(5):522–554. doi:10.1177/1077558714541480

Objective To determine if the sensitivity of the lateral flow test is dependent on the viral load and on the location of swabbing in the respiratory tract in children. Design Phase 1: Routinely performed reverse transcriptase PCR (RT-PCR) using nose and throat (NT) swabs or endotracheal (ET) aspirates were compared with Innova lateral flow tests (LFTs) using anterior nasal (AN) swabs. Phase 2: RT-PCR-positive children underwent paired AN RT-PCR and LFT and/or paired AN RT-PCR and buccal LFT. Setting Tertiary paediatric hospitals. Patients Children under the age of 18 years. Phase 1: undergoing routine testing, phase 2: known SARS-CoV-2 positive. Results Phase 1: 435 paired swabs taken in 431 asymptomatic patients resulted in 8 positive RT-PCRs, 9 PCR test failures and 418 negative RT-PCRs from NT or ET swabs. The test performance of AN LFT demonstrated sensitivity: 25% (4%–59%), specificity: 100% (99%–100%), positive predictive value (PPV): 100% (18%–100%) and negative predictive value (NPV): 99% (97%–99%). Phase 2: 14 AN RT-PCR-positive results demonstrated a sensitivity of 77% (50%–92%) of LFTs performed on AN swabs. 15/16 paired buccal LFT swabs were negative. Conclusion The NPV, PPV and specificity of LFTs are excellent. The sensitivity of LFTs compared with RT-PCR is good when the samples are colocated but may be reduced when the LFT swab is taken from the AN. Buccal swabs are not appropriate for LFT testing. Careful consideration of the swabbing reason, the tolerance of the child and the requirements for test processing (eg, rapidity of results) should be undertaken within hospital settings. Trial registration number NCT04629157 .