1030 Paediatric Appendicectomy - Appropriateness of Operative Intervention

Aim

Acute appendicitis is one of the most common paediatric surgical emergencies. Prompt diagnosis and interventions reduce the risk of perforation and prevents complications. The aim of the audit was to determine the appropriateness of operative intervention and to improve patient care by implementing changes. We assessed several performance indicators including the percentage of appendicectomy performed within 12 hours of decision to operate, the percentage of negative appendicectomy and the 30 days re-admission rate.

Method

All consecutive paediatric patients who had appendicectomy in our district general hospital from Jan 2017 to 2019 were included in the initial audit. For re-audit, we collected data from July 2019 to March 2020. Patients were identified from the theatre system and ward notes, theatre charts and biochemistry and histology results were collected from the electronic patient records.

Results

A total of 193 patients were included in the initial audit. Results showed that 52.8% of patients were reviewed by a consultant prior to surgery, 92% of patients had surgery within 12 hours of the decision to operate. The rate of negative appendicectomy rate was 25%.

Conclusions

Following this audit, several changes have been implemented including improving consultant review of paediatric patients, increasing imaging done by radiologists for paediatric patient. Re-audit showed that 86.7% of patients were reviewed by a consultant preoperatively. Negative appendicectomy rate remained the same at 24.4%. Admissions within 30 days of discharge improved from 13.8% in the initial audit to 11.5% in re-audit.

Regular consumption of Nile river fish could ameliorate the low milk DHA of Southern Sudanese women living in Khartoum City area

We have reported that milk of Northern Sudanese women contained very low level of docosahexaenoic acid (DHA). This was puzzling since the mothers were not malnourished and some had claimed to eat fish from time to time. War-displaced Southern Sudanese live in Khartoum City and its vicinity. They are distinct in genetic background and traditional dietary culture from the Northerners. Milk DHA is influenced by diet and ethnicity. Fatty acid content of Southern Sudanese milk, and six of the popular River Nile fish species were evaluated. Mature milk compared with transition milk had lower arachidonic (AA, 0.6±0.19 vs. 0.75±0.3; p<0.001), adrenic (0.14±0.1 vs. 0.33±0.23), osbond (0.07±0.05 vs. 0.14±0.08; p<0.0001), eicosapentaenoic (0.04±0.02 vs.0.08±0.07; p<0.01) and DHA (0.10±0.07 vs. 0.16±0.1; p=0.003) acids. The milk of the Southerners like their counterparts from the North had low DHA and total n-3 and high AA and total n-6 levels. Regular consumption of the local fish could provide adequate DHA to help enrich their milk.