SUMMARYA 21-year-old patient presented with a 3-day history of shortness of breath, productive cough, fatigue, fevers and night sweats, associated with right upper quadrant pain. He had an appendicectomy 3 months previously. The CT images showed a right subphrenic collection, which was indenting the right lobe of the liver, with an appendicolith in the middle. He underwent laparoscopic surgery where the abscess was drained and the appendicolith was retrieved. The patient had an uncomplicated postoperative period and was discharged soon afterwards. Complications from spilled appendicoliths have been reported previously. Retained appendicoliths and gallstones can act as niduses for infection, and thus cause symptoms at a later stage. Surgical notes should include the findings of appendicoliths, and in the event where retrieval is not possible, a clear record of this must be made, and the patient along with the general practitioner need to be informed. BACKGROUND

Previous pilot work has shown high acceptability with parents and children, and suggests digital-clinical interaction typically takes 10-15 minutes to complete, fitting well into a standard 60-90 minute initial paediatric developmental assessment. Conclusions The Pirates app shows promise as a tool that can be used alongside initial clinical assessment including history taking and information from school, to determine whether full, detailed, diagnostic assessment is required. In some cases, it may support an early and shortened diagnostic pathway of the child at the initial stage of the diagnostic process. By improving early decision making, including increasing confidence in deciding whether or not a child needs to proceed to full diagnostic assessment, this could help improve the timeliness of diagnostic assessment, and reduce service delivery costs.