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More than 50.000 patients suspected with acute appendicitis are referred to the Emergency Department annually in the Netherlands. The current Dutch appendicitis guideline recommends an ‘imaging for all’ strategy, which is associated with high health care utilization and costs. However, in 35% of these patients appendicitis can be ruled out by using clinical risk prediction models and imaging can be avoided, suggesting an ‘imaging as needed’ diagnostic strategy. This ‘imaging as needed’ diagnostic strategy may reduce health care utilization and costs. To prepare a clinical trial aiming to optimize the diagnostic strategy of patients suspected with acute appendicitis by use of a risk prediction model(s), multidisciplinary collaboration is needed. Firstly, a patient advisory board will be formed and interviews with patients will be conducted to gain insight in their perceptions towards different diagnostic strategies (activity 1). Also, a collaboration will be initiated with Dutch research groups conducting appendicitis research to create an extensive network of participating centers needed for inclusion of patients and execution of the intended clinical trial (activity 2). In addition, in order to optimize the use of clinical prediction models for the Dutch clinical setting, members of both national and international research groups involved in previous studies of the risk prediction models as well as methodological experts will be contacted to collaborate and to share their insights and expertise (activity 3). With the intended collaborations and activities, we will be able to design a societally relevant clinical trial and build an extensive network to support study participation and subsequent implementation.

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