Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • a child with abdominal mass and any of the following symptoms:
    • compressive symptoms
    • uncontrolled pain
    • irritability
    • unexplained neurological symptoms (Horner’s in neuroblastoma)
  • symptoms of bone marrow involvement such as:
    • pallor
    • bruising
    • fever
  • if lymphoma is considered, contact the on call Paediatric Haematology Oncology team for an urgent clinic review or refer to ED. Do not wait for or do extensive blood work-up or other imaging

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Inclusions

  • unexplained hepatomegaly and/or splenomegaly

Exclusions

  • palpable abdominal mass +/- pain (usually seen within 48 hours) – please refer to paediatric surgery (usually via the emergency department)

Triage categories

Category 1 (appointment clinically indicated within 30 days) 

  • hepatomegaly otherwise unexplained, usually seen within 2 weeks
  • unexplained splenomegaly with fever, sweat, breathlessness, pruritus, or weight loss,  generally seen within 48 to 72 hours given urgency of most paediatric cancers.

Category 2 (appointment clinically indicated within 90 days)

  • asymptomatic splenomegaly

Category 3 (appointment clinically indicated within 365 days)

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • family history
  • important psychosocial history or other barrier to accessing care
  • relevant medical history
  • blood results
    • complete blood examination (CBE)
    • liver function tests (LFTs)
    • lactate dehydrogenase (LDH)
    • electrolytes, urea, creatinine (EUC)
    • calcium
    • phosphate
    • uric acid
  • results of all prior relevant investigations

Additional information to assist triage categorisation

  • coagulation studies
    • international normalised ratio (INR)
    • activated partial thromboplastin time (APTT)
    • fibrinogen
  • any other relevant imaging including reports and hard copies for ultrasound, computed tomography and magnetic resonance imaging, if completed

Clinical management advice

In South Australia, cancer care for individuals aged <18 years is centralised to Women’s and Children’s Hospital.

In general:

  • abdominal masses thought to be lymphoma will be seen by haematology oncology rapidly.
  • all other abdominal masses will be seen primarily by surgeons who will involve an oncologist in their investigation and treatment.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.