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.

  • severe/uncontrollable pain unresponsive to first-line management
  • suspected acute pilonidal abscess

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

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Regional Health Networks

Barossa Hills Fleurieu Local Health Network

Eyre and Far North Local Health Network

Flinders and Upper North Local Health Network

Limestone Coast Local Health Network

Riverland Mallee Coorong Local Health Network

Yorke and Northern Local Health Network


Exclusions

  • asymptomatic pilonidal sinus

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • persistent pilonidal sepsis

Category 2 (appointment clinically indicated within 90 days)

  • chronic pilonidal disease with or without recurrent infection or abscess with impact on acts of daily living /employment

Category 3 (appointment clinically indicated within 365 days)

  • chronic pilonidal sinus

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.

  • cultural considerations
  • age
  • past medical/surgical history
  • medications and dosages
  • allergies and sensitivities
  • height, weight and body mass index (BMI)
  • smoking, alcohol and other drug use
  • onset, duration, and progression of symptoms
  • presenting symptoms
    • pain, swelling, and redness of the overlying skin
    • painless lump (cyst)
    • presence of discharge (indicating sinus)
    • previous management trialled and outcomes
    • social and emotional impact e.g. acts of daily living/employment
  • examination findings
    • associated cellulitiS
    • enlarged inguinal glands or lymph nodes
    • presence of discharge indicating sinus
    • systemic symptoms such as fever, malaise or nausea
    • tender lump with/without overlying erythema (abscess formation)
    • visible or lumpy tracts in those with chronic or recurrent disease
    • relevant diagnostic/imaging reports, including location of company and accession number

Clinical management advice

The management of a pilonidal sinus typically involves a combination of conservative measures, minimally invasive procedures, and surgical intervention. The specific treatment approach may vary depending on the severity of the condition and the individual's symptoms.

Community management for pilonidal sinus may include:

  • hygiene management to ensure the area remains clean and dry
  • applying warm compress to reduce pain and promote drainage
  • avoid prolonged sitting to offload the area
  • encourage regular analgesia to reduce pain and discomfort
  • consideration of laser hair removal

The choice of treatment depends on factors such as the extent of the sinus, the presence of infection, recurrence rates, and individual patient factors. Follow up review is advised for ongoing assessment and monitoring.

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.