Grant: Project Grant

Appendicitis is the most common surgical emergency in children. Early, accurate diagnosis is important to decrease the risk of serious complications such as rupture of the appendix, severe infection and death. Basic blood and imaging tests are currently used to diagnose appendicitis. However these tests lack accuracy and availability, are time-consuming, painful and potentially harmful (radiation) resulting in significant differences in the way doctors diagnose children with appendicitis in Emergency Departments (ED) across Canada. Precision Medicine uses next-generation laboratory testing of molecules (biomarkers) to find distinct patterns (bio-profiles), that act like a fingerprint; they pick out a specific disease amongst similar illnesses. We have found that bio-profiles can identify which abdominal pain is caused by appendicitis, and determine how severe the illness is. The goal of this study is to evaluate the accuracy of these bio-profiles in children across age, sex, and geographic location and to compare them to currently used investigations. This study will be performed at 10 pediatric EDs across Canada. We will include children aged 0-17 years with suspected appendicitis. Blood and urine will be tested for biomarkers (metabolites, proteins and metals) using advanced technologies (nuclear magnetic resonance, mass-spectrometry, multi-plex assays). Clinical data will be collected from the health record. Using multivariate statistics we will determine the bio-profiles that best identify children with appendicitis and compare their accuracy to those of current appendicitis investigations. Our study will result in bio-profiles that can accurately identify children with appendicitis. These bio-profiles can be made into point-of-care (POC) technologies that can be used at the bedside. Rapid, accurate, accessible, economic POC tests can improve efficiency in the ED, access to diagnostic tests, therapeutic decision making and patient outcomes and satisfaction.