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.

  • any suspected pathological fracture, contact paediatric orthopaedic surgery for an urgent clinic review or refer to emergency
  • if a central nervous system tumour is suspected, or there is neurological compromise, contact paediatric neurosurgery for an urgent clinic review or refer to emergency. For example
    • collapse/seizure/altered level of consciousness/new neurological deficit
    • severe and increasing headache
    • symptoms or signs of raised intracranial pressure
  • any mass with or symptoms of:
    • neurovascular compromise
    • significant functional impairment
    • pain uncontrolled by simple analgesia

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

Queries relating to the surgical management of bone tumours can also be directed to the South Australian Sarcoma & Bone Tumour Unit based at Flinders Medical Centre

Inclusions

  • mass of uncertain origin

Exclusions

  • musculoskeletal tumours should primarily be referred to orthopaedics
  • brain / spinal tumour – initial referral to paediatric neurosurgery often via emergency department. See Brain and Spinal Tumours - Paediatric CPC for more information
  • incidental lytic lesion on imaging – refer to orthopaedics
  • chest wall tumours – refer to paediatric surgery

Triage categories

Category 1 (appointment clinically indicated within 30 days) [although generally seen within 48-72hrs given urgency of most paediatric cancers]

  • unexplained enlarging soft tissue mass
  • suspected malignancy with presence of red flags:
    • scrotal swelling
    • blood stained vaginal discharge
    • back pain, bone pain, weakness, limp
    • pain that wakes overnight
    • urinary retention
    • proptosis
    • persistent, recurrent bloody, purulent discharge from ear or nose

Category 2 (appointment clinically indicated within 90 days)

  • slow growing suspicious lesion
  • continued care or review of a known patient on treatment
  • new non-urgent cancer related problem in known patient
  • cancer patients whose ongoing care is being transferred from elsewhere

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)
    • c-reactive protein (CRP)
  • results of all prior relevant investigations

Additional information to assist triage categorisation

  • ultrasound (US), X-ray, computed tomography (CT) scan results as available

Clinical management advice

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

Refer as soon as there is a suspicion. This may include bony masses or lesions, enlarging supraclavicular masses, localised pain with no obvious diagnoses, recurrent presentations, a child who is not right.

There is no need for a tissue diagnosis or multiple investigations. This includes fine needle aspirates. We will arrange the appropriate investigations and biopsies. If tests have been ordered, please send ALL results with referral including histopathology and imaging.

If there are any abnormal findings on imaging, call the paediatric oncology fellow or paediatric oncology consultant on-call.

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.