Hernia, hydrocele and testicular conditions
Paediatric

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Paediatric surgery registrars at Queensland Children's Hospital/ GCUH can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local paediatric medical service or general surgery services:

• Queensland Children's Hospital: (07) 3068 1111
• GCUH: 1300 744 284

Burns

Paediatric surgery registrars at Queensland Children's Hospital/[CM1] GCUH can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local paediatric medical service or general surgery services:

Queensland Children's Hospital: 07 3068 1111
Gold Coast University Hospital: 1300 744 284
Townsville: 4433 3642 (4433 1111 Nights)

All major burns require emergency management and referral

Catchment areas:

Mackay region and above, please refer to Townsville Hospital first (07) 4433 1111
Gold Coast region and in Northern New South Wales down to Grafton, please refer to Gold Coast University Hospital first. Paediatric surgical registrar or on call surgical cover 1300 744 284
The Pegg Leditschke Children’s Burn Centre (PLCBC), Qld Children's Hospital offers a 24/7 referral service. For a referral coming from regional QLD, an online referral service is available. Criteria for referring to our service is based on the Australian New Zealand Burns Association transfer guidelines for Burns Service referral.

To refer a patient to the Pegg Leditschke Children’s Burns Centre at Queensland Children's Hospital:

Contact the Burns on call phone via switch (07) 3068 1111
Fill in the referral form: https://econsult.acclario.com.au/chq/telehealth/burns/
If advised that the patient can be treated locally, continue to contact Burns on-call phone at each dressing change to update progress and send through photos to the email address CHQ_QCHburns@health.qld.gov.au

Most paediatric patients referred to any of the centers do not require physical attendance at the facility, as treatment can be offered at local facilities

Antenatal & neonatal surgical conditions

Patients with congenital malformations causing bowel obstruction or respiratory compromise are emergency referrals not outpatients. Resuscitation and safe transfer to tertiary paediatric unit is a priority. Notify neonatal unit or appropriate neonatal/paediatric medical specialist of neonatal/fetal diagnosis as per local protocol.
Acute neonatal bowel obstruction

Abdominal pain - chronic

Acute abdominal pain (suspected serious pathology) especially severe pain or peritonitis
Intussusception
Hypertrophic pyloric stenosis
Suspected bowel obstruction with bile stained vomiting
Suspected malignancy – discuss with on-call paediatric surgical registrar if serious pathology is suspected

Constipation and encopresis

Acute neonatal bowel obstruction

Enlarged lymph bodes/midline neck swelling

Acute infective node with no improvement within 48 hours
Nodes rapidly increasing in size, overlying skin erythema or very tender
Acute infection not responding to treatment/antibiotics

Facial Masses

Respiratory compromise or rapidly escalating issues with swallowing

Hernia, hydrocele and testicular conditions

Irreducible, incarcerated or strangulated inguinal hernia
Suspected testicular torsion
Inguinal hernia: If under <52 weeks post conceptual age, call nearest paediatric surgical unit for urgent review
Acute scrotal pain with or without swelling
Ambiguous genitalia Paediatric General Medicine/Paediatric Endocrinology (depending on local resources)
Neonatal bilateral undescended testes are urgent referrals to service

Midline neck swelling

Respiratory compromise, acute abscess or infection midline neck not responsive to treatment/antibiotics present to emergency

Ovarian Conditions

Acute ovarian torsion

Penile conditions

Paraphimosis (when unable to replace foreskin)
Variations of Sexual Characteristics (previously known as Disorder of sexual development) – refer to paediatric surgeon or paediatric medicine immediately

Perineal conditions

Severe abdominal pain or peritonitis

Perianal conditions

Acute abscess causing distress or sepsis

Renal and bladder congenital lesions

Acute retention
Poor urinary stream in neonate / suspected valves

Skin and soft tissue masses

Acute breast infection requiring admission or drainage
Acute infection - if unresponsive to treatment or acutely unwell from infection
Acute infection requiring admission or drainage
Suspected solid paediatric tumours should be urgently referred through local paediatric medical service and/or paediatric oncology services

Stomas and abdominal devices

Accidental removal of gastrostomy button or ACE tubing – phone on-call paediatric surgical registrar
Any stomal or abdominal device issues refer to treating hospital

Umbilical and peri umbilical pathology

Any painful, red, or irreducible hernia – discuss with on-call paediatric surgical registrar
Suspected vitello-intestinal remnant or patent urachus

Urinary tract infections (UTI)

Acute infant urinary tract infection presenting septicaemia or acutely unwell
Hypertension > 97 percentile for age and/or height
Presumed UTI in infant <3 months

Vascular anomalies/haemangioma

Obstruction of vision, airway compromise, uncontrolled bleeding, ulceration, suspected kaposiform haemangioendothelioma (KHE) or cardiac output compromise - contact paediatric surgical registrar on call

Vomiting

Phone the on-call surgical registrar for:

Bile stained vomiting (a surgical emergency)
Suspected pyloric stenosis usually ≤ 6 weeks of age
Suspected intussusception approx. 3 months to 3 years age
Suspected strangulated inguinal hernia/gonadal torsion

Useful Management Information

Principles of reduction include:
apply firm continuous pressure with one hand to the mass and with the other hand direct the hernia contents through the superficial ring. Your second hand should be placed just medial to the midpoint of the inguinal ligament and push inferiorly and medially
In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
An USS does not contribute to management for UDT, hydrocele, testicular pain
Paediatric surgery registrars at Queensland Children's Hospital/ GCUH/ Townsville can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local paediatric medical service or general surgery services:
- Queensland Children's Hospital: 07 3068 1111
- Gold Coast University Hospital: 1300 744 284
- Townsville: 4433 3642 (4433 1111 Nights)
Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient appointment
If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
Statement of intent – the prioritisation of health services for children and young people in the child protection system

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Child ≤ 6 months with Inguinal Hernia or uncertain diagnosis Acute scrotal pain/incarcerated hernia, suspected torsion should be emergency referrals to local surgical service Scrotal tumour/mass Intermittent scrotal pain A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 2 (appointment within 90 calendar days)	Inguinal hernia ≥ age of 6 months Hydrocele if it persists > 2 years or causes symptoms or grows rapidly Unilateral undescended testis ≥ age of 3 months Transilluminable swelling
Category 3 (appointment within 365 calendar days)	Retractile testis – referral after the age of 2 years
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

Essential Referral Information

Onset and severity
Is the swelling reducible?
Trauma
Prior genitourinary surgeries / known urological abnormality (if applicable)
If referral for undescended testicle (UDT) – then what was the neonatal exam / 6 week check result
Confirmation of out of home care (OOHC) (where appropirate)

Additional Referral Information

For irreducible inguinal hernia
- keep fasted and give paracetamol prior to transfer to emergency
Reassurance uncomplicated hydrocele is elective surgical condition

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Not Available

Internal Referrals

Paediatric Surgery (E-Blueslips)

Fax

(07) 5687 4497

Post

Paediatric Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

(07) 5687 3579

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

A/Prof Deborah Bailey

Medical Director Paediatric Surgery, and Paediatric Urology

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Child Safety

If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, contact Department of Children, Youth Justice and Multicultural Services . Please consider if mandatory reporting applies.

Hernia, hydrocele and testicular conditionsPaediatric