Article Text

Download PDFPDF

Right Iliac Fossa Pain Treatment (RIFT) Study: protocol for an international, multicentre, prospective observational study
  1. RIFT Study Group On behalf of the West Midlands Research Collaborative
  1. The West Midlands Research Collaborative, The Department of Academic Surgery, University of Birmingham, Birmingham, West Midlands, UK
  1. Correspondence to Dmitri Nepogodiev; d.nepogodiev{at}


Introduction Patients presenting with right iliac fossa (RIF) pain are a common challenge for acute general surgical services. Given the range of potential pathologies, RIF pain creates diagnostic uncertainty and there is subsequent variation in investigation and management. Appendicitis is a diagnosis which must be considered in all patients with RIF pain; however, over a fifth of patients undergoing appendicectomy, in the UK, have been proven to have a histologically normal appendix (negative appendicectomy). The primary aim of this study is to determine the contemporary negative appendicectomy rate. The study’s secondary aims are to determine the rate of laparoscopy for appendicitis and to validate the Appendicitis Inflammatory Response (AIR) and Alvarado prediction scores.

Methods and analysis This multicentre, international prospective observational study will include all patients referred to surgical specialists with either RIF pain or suspected appendicitis. Consecutive patients presenting within 2-week long data collection periods will be included. Centres will be invited to participate in up to four data collection periods between February and August 2017. Data will be captured using a secure online data management system. A centre survey will profile local policy and service delivery for management of RIF pain.

Ethics and dissemination Research ethics are not required for this study in the UK, as determined using the National Research Ethics Service decision tool. This study will be registered as a clinical audit in participating UK centres. National leads in countries outside the UK will oversee appropriate registration and study approval, which may include completing full ethical review. The study will be disseminated by trainee-led research collaboratives and through social media. Peer-reviewed publications will be published under corporate authorship including ‘RIFT Study Group’ and ‘West Midlands Research Collaborative’.

  • abdominal pain
  • surgery
  • appendicitis
  • appendicectomy
  • right iliac fossa pain

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Twitter @WMRC_UK

  • Contributors Conception and writing of protocol: Jacob H Matthews, Gabriella L Morley, Shivam Bhanderi, Sarus Jain, Imran Mohamed, Thuvarahan Amuthalingam, Robert Tyler, James C Glasbey, Richard Wilkin, Dmitri Nepogodiev, Aneel Bhangu. Participation in collaborator meeting, development of study concept and editing of protocol: Jacob H Matthews, Gabriella L Morley, Shivam Bhanderi, Sarus Jain, Imran Mohamed, Thuvarahan Amuthalingam, Robert Tyler, James C Glasbey, Ewen Griffiths, Thomas Pinkney, Oliver Gee, Dion Morton, Francesco Pata, Gianluca Pellino, Valeria Farina, Laura Gavagna, Pietro Maria Naccari, Sandro Pasquali, Bruno Sensi, Alessandro Sgrò, Andrea Simioni, Ruth Blanco-Colino, Matteo Frasson, Antonio Sampaio Soares, Natalie Blencowe, Will Bolton, Stephen Chapman, Catherine Bradshaw, Grant Harris, James B Haddow, Kapil Sahnan, John Mason, Scott McCain, David Milgrom, Saleem Noor Mohamed, James O’Brien, Jack Pearce, Mohammed Rabie, Gaël R Nana, Panchali Sarmah, Nigel Jamieson, Richard Wilkin, Dmitri Nepogodiev, Aneel Bhangu. Guarantor: Aneel Bhangu. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Ethics approval In the United Kingdom this observational study does not require research ethics approval. The study will be registered as a clinical audit in each participating UK centre. National leads in the other participating countries will ensure appropriate registration and study approval in compliance with local regulations;, this may require full ethical review in some jurisdictions. Local investigators are responsible for ensuring local approvals are in place.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators WMRC Collaborating members are listed in the online supplementary appendix 1.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.