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Pediatric patients transferred for operative management of appendicitis: are they at a disadvantage?
Sandra M Farach1, Paul D Danielson1, N Elizabeth Walford1
1Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA.
Insights
Pediatric appendicitis patients transferred to a specialized center had similar outcomes but higher radiation exposure. This highlights the need to optimize imaging protocols for transferred patients with appendicitis.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Healthcare Management
Background:
- Many pediatric appendicitis cases are diagnosed at referring hospitals before transfer.
- Transferring patients to specialized pediatric facilities is common practice.
Purpose of the Study:
- To compare outcomes of pediatric appendicitis patients transferred to a referral center versus those presenting directly.
- To evaluate differences in disease severity, treatment, and complications between the two groups.
Main Methods:
- Retrospective review of 326 pediatric appendicitis patients (July 2012-July 2013).
- Analysis of demographic data, clinical parameters, and patient outcomes.
- Comparison between transferred (n=222) and primary (n=104) patients.
Main Results:
- Transferred patients were younger (11.2 vs. 12.4 years).
- Transferred patients underwent more CT scans (80% vs. 40%).
- No significant differences in diagnosis-to-appendectomy time, hospital stay, or 30-day complications were observed.
Conclusions:
- Transferred pediatric appendicitis patients do not present with more advanced disease or experience increased complications.
- Transferred patients receive significantly more ionizing radiation during their evaluation.
- Optimizing imaging strategies for transferred appendicitis patients is warranted to reduce radiation exposure.
Purpose:
Many pediatric patients are initially diagnosed with appendicitis at referring hospitals and are subsequently transferred to pediatric facilities. We aimed to compare outcomes of patients transferred to a pediatric referral center to those who present primarily for operative management of appendicitis.
Methods:
A retrospective review of 326 patients with operative appendicitis from July 2012 to July 2013 was performed. Demographic data, clinical parameters, and outcomes were analyzed.
Results:
Transferred (n=222, 68%) and primary patients (n=104, 32%) were similar except for mean age (primary 12.4 vs. transferred 11.2 years, p<0.01). Computed tomography scans were performed in 80% of transferred compared to 40% of primary patients. Primary patients were more likely to present between the hours of 09:00 and 17:59 (52%), while transferred arrived equally across all hours. Both groups were more likely to present with acute appendicitis (primary 56% vs. transfer 61%, p=NS). There was no difference in time of diagnosis to time of appendectomy, length of hospital stay, or 30 day complications (primary 8.6% vs. transfer 5.8%, p=NS).
Conclusions:
Patients transferred for definitive care of appendicitis are not found to have more advanced disease or have increased complications; however, they are exposed to significantly more ionizing radiation during evaluation for appendicitis.
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