Characterizing Inequities in Pediatric Appendicitis Delayed Diagnosis and Perforation
Stephen Trinidad1, Raphael Parrado1, Amelia Gavulic2
1Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Journal of Pediatrics. Clinical Practice
|June 3, 2024
Summary
Sociodemographic factors like age, sex, and socioeconomic status significantly impact the risk of delayed diagnosis and perforation in pediatric appendicitis. Older children have lower odds, while females and those from disadvantaged backgrounds face increased risks.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Epidemiology
Background:
- Pediatric appendicitis is a common surgical emergency.
- Delayed diagnosis and perforation are significant complications.
- Sociodemographic factors may influence appendicitis outcomes.
Purpose of the Study:
- To investigate the association between child sociodemographic characteristics and the likelihood of delayed diagnosis and perforation in pediatric appendicitis.
- To identify specific demographic and socioeconomic factors contributing to adverse appendicitis outcomes in children.
Main Methods:
- Retrospective cohort study of 3248 pediatric appendicitis admissions (2016-2021).
- Multivariable analysis to assess associations between sociodemographics (age, sex, race/ethnicity, insurance, socioeconomic status) and outcomes.
- Key outcomes: delayed diagnosis and perforation.
Main Results:
- Delayed diagnosis occurred in 6.4% and perforation in 25.1% of cases.
- Delayed diagnosis was associated with a higher perforation rate (56% vs 21.5%).
- Increased odds of delayed diagnosis were linked to female sex and socioeconomic disadvantage; older age decreased odds.
- Increased odds of perforation were associated with non-Hispanic Black and Hispanic race/ethnicity, and socioeconomic disadvantage; older age decreased odds.
Conclusions:
- The study identified a higher delayed diagnosis rate than previously reported, emphasizing the need to consider diverse healthcare settings.
- Sociodemographic factors, particularly socioeconomic status, race/ethnicity, and sex, significantly impact children's risk of delayed diagnosis and perforation in appendicitis.
- Findings underscore the importance of addressing social determinants of health to improve pediatric appendicitis outcomes.
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