SAQ 310 – Paediatrics – appendicitis consent and mature minor

Paediatrics – appendicitis consent and mature minor.

a. Ultrasound features

• Appendiceal diameter >6 mm.
• Target sign with concentric layers.
• Distended or obstructed appendiceal lumen.
• Increased echogenicity around the appendix.
• Appendicolith.
• Pericaecal or perivesical free fluid.
• Muscular wall thickness >2 mm.
• Absent appendiceal peristalsis.

b. Perforation-suggesting history

• Pain for more than 36 hours.
• Pain-free interval.
• Diffuse rather than isolated right iliac fossa pain.
• Vomiting.
• Fever.
• Altered bowel habit.

c. Unable to give informed consent

• Consent is not voluntary or is coerced.
• Lack of capacity.
• Minor without mature-minor competence for the decision.
• Inadequate information about procedure or risks, or consent taken by someone unfamiliar with them.
• Subject to relevant mental health legislation.
• Unable to comprehend the information presented.

d. Mature minor

• A person under 18 can be assessed as mature, with no fixed lower age threshold.
• They must show a reasonable thought process and insight into the decision.
• A mature minor may consent to treatment, but cannot refuse life-saving treatment in this context.