To ask that Out of Hours GP does bloods tonight

[SnugNightsss]

We’ve got an appointment for my child this evening. I’m concerned it might be appendicitis. I have not had good experiences at the out of hours service locally. Those who’ve had children with appendicitis, how did they diagnose it? Should I ask that they take blood to check for infection markers? Anything else I should be aware of?

Ultrasound doesn’t diagnose it either.

They will take blood, prod and guess.

My son was diagnosed after ultrasound scan. No bloods.

ultrasound is commonly used to help diagnose appendicitis.

DD had appendicitis at the end of January. We arrived at A&E at 1pm, she was on a ward by 4pm - they didn’t mess about. Her bloods were actually OK, she was scanned but they couldn’t actually see her appendix. She was presenting with typical symptoms however so they recommended surgery. Her appendix was inflamed but caught early and it was the right decision to remove it.

Her surgery went smoothly, she had 2 weeks off school and 4 off sport, but no complications at all. She’s just got back from the school ski trip and completely back to normal. I hope you get a diagnosis soon OP and if it is appendicitis, all goes well.

Ultrasound can be used to aid diagnosis. I have plenty of patients that have them. Sometimes it’s spotted, sometimes not.

I had an ultrasound when I was in hospital with appendicitis. It didn't show anything but they (eventually) operated anyway and it was appendicitis. So they do use ultrasounds but they're not always diagnostic.

Hope you get sorted out OP you've definitely done the right thing

Thank you. We’re on the ward now & I think they said the bloods were ok, but another Nurse was talking at the same time. So I’m going to check when they come back. Her temp is up again. So they’re going to give more paracetamol & she’s had anti sickness. She doesn’t look as pale now, so I’m hoping they might let us go. Although saying that I’ll probably worry if they do!
When her Dad had appendicitis the hospital was completely full, so they said because he’d been sick once it must have been a gastrointestinal bug. They sent us home and he was back in 2 days later, sent by the GP & was in for days after surgery really unwell.

Glad you took her to A&E, was definitely an A&E job (though I don't understand why GPs in the UK don't use the fingerprick CRP test, such a quick and easy way to check infection markers, especially good for figuring out if an infection is bacterial, they even have ones now that are combined with other infection markers)

Ultrasound is used to diagnose appendicitis if its not clear from physical exam, though it's not always useful - ultrasound didn't show when I had appendicitis but an MRI did (but I was pregnant so all my organs were all squashed and moved around so that might have affected it)

CRP is a non-specific inflammatory marker - it is not specific for infection. It can be surprisingly low in early appendicitis (and in very severe infections). GPs can't treat appendicitis. There is no role for fannying about with fingerprick tests in kids in a GP practice if there are signs that they need to be seen in a hospital.

But your GP won’t be given the same priority for results as inpatients and those waiting in A&E.

Edited to say I’ve seen your updates. Glad she’s being seen. Don’t let them fob you off though. A family member was sent home - misdiagnosed as a stomach bug when it was appendicitis. They were really unwell as a result.

I'm glad she is perking up a bit now, bless her x

If they suspect it's the appendix, they will refer you to hospital/send you to a&e for assessment. I doubt out of hours so bloods. If you think it's appendicitis, I would head to a&e.

CRP is used widely in my country for checking for infections but with appendicitis the physical exam is the main way of diagnosing, of course, but in other infections, especially respiratory, CRP is extremely useful and lessens the use of unnecessary antibiotics. But the quick tests also have other infection markers too these days.

Next time you see the nurse ask for clarification on the bloods. Hopefully it's just gastritis or similar but I hope they do check very thoroughly and if they send you home have a very low threshold for going back. Appendicitis can be tricky sometimes to spot.

it is NOT a specific marker of infection. It is an inflammatory marker and one cause of inflammation is infection, but there are plenty of other things that cause inflammation too. While CRP is often high in infection, a high CRP is not diagnostic of infection and it's not at all unusual to see normal CRPs in early appendicitis. It is not a marker used in isolation to make decisions re antibiotic prescribing in this context - the history, examination and the rest of the blood tests/other investigations will help determine what the likely differential is and it's the combination of things that determines treatment. In the context that the OP is describing a fingerprick test for a non-specific marker would contribute nothing to the decision making - an unwell child needs to be seen in a setting that can diagnose and treat that illness properly and if you're going to stick a needle in at all you're better off doing it properly and getting all the tests you need.

It’s commonly used to try and image the appendix in children but often fails in adults. CT is preferred but I don’t know how much it’s used in the NHS. I wasn’t given a CT. It’s ultimately somewhat down to guesswork - in 15-40% of appendectomies the appendix turns out to be fine.,

Appendicitis is diagnosed by physical examination and not by "bloods".

Exactly. Me too.

Perhaps you'd like to tell the doctors of my country that they are doctoring wrong... of course it's not used in isolation but it is very useful for distinguishing between viral and bacterial infections, and for helping determine if recovery from infection is heading in the right direction.

Finger prick tests are used in situations where using a needle for proper tests isn't possible or will be delayed. When they can do a fbc and other tests that is obviously preferable.

And as I already said, for suspected appendicitis a physical exam is the primary way of diagnosing as it has clear physical symptoms (and imaging can be useful too but not always)

the doctors in your country are using it in a completely different context - I'm sure their doctoring is spot on for what they need it for. The inference of your original comment, whether you meant it or not, was that a finger prick crp would've been useful for the OPs child if they'd gone to the GP and that is not true and our GPs would not be deficient for not offering it. Outpatient CRP monitoring is useful in some contexts, usually where the underlying problem is known and a response to treatment is being monitored. It is still not a specific marker for infection, it is a marker of inflammation (one cause of which may be infection). In the acute phase of an illness, a wildly high CRP often supports that there's bacterial infection (but that'd often be barn door obvious anyway), but a slightly raised CRP (or even a normal CRP very early on) doesn't necessarily exclude bacterial infection so you'd treat based on clinical suspicion and the rest of the tests. It matters not one bit that it can be used to make decisions/monitor respiratory illnesses (your example) when the OP's child is presenting with an undifferentiated acute abdomen. Hope that clarifies my point. As a bit of an aside, a finger prick test that's perhaps more likely to be useful in a sleepy, unwell child with belly ache would be glucose.

How are things? @SnugNightsss

Much better, thanks for asking. They let us go home at midnight. After some anti sickness in A&E they sent us up to the Children's Ward. Her examination in A&E was worrying the doc as she was tender over her appendix and crying when he touched that area. A few hours later though when the Paeds doc examined her again, she was tender all over her stomach. So they think it’s just a virus.
She hasn’t been sick since we got home and only woke a few times in the night. They’ve given us 48 hours access and asked us to get a stool sample, because we didn’t manage that on the ward.
I’ll obviously keep a very close eye on her and go straight back if we need to. Fingers crossed it was a false alarm though.

Glad she's doing ok OP, definitely keep a low threshold for going back but does sound more like a stomach bug.