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.
Insights
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.
Objective:
We sought to characterize the impact of a child's sociodemographic characteristics on their odds of delayed diagnosis and perforation in pediatric appendicitis.
Study Design:
We performed a single-center, retrospective cohort study of all pediatric appendicitis admissions between 2016 and 2021. Using a multivariable model, we evaluated for associations between delayed diagnosis and perforation and a child's sociodemographic characteristics, including their age, sex, race and ethnicity, insurance status, and their home census-tract Material Community Deprivation Index value.
Results:
The study included 3248 patients. The median age was 12.1 years (IQR 9.5-14.9 years). Most patients were male (60.3%), identified as non-Hispanic White (78.0%), and had private insurance (55.4%). The delayed diagnosis and perforation rates were 6.4% and 25.1%, respectively. Delayed diagnosis cases had a greater perforation rate (56% compared with 21.5%, P < .001). On adjusted analysis, older age decreased the odds (OR 0.91, CI 0.87-0.94) of delayed diagnosis, whereas female sex (OR 1.50, CI 1.13-2.00) and socioeconomic disadvantage (OR 1.56 for quartile 4 vs quartile 1, CI 1.00-2.43) increased the odds. Furthermore, older age (OR 0.91, CI 0.89-0.93) decreased the odds of perforation, whereas non-Hispanic Black (OR 1.72, CI 1.3-2.29) or Hispanic (OR 1.60, CI 1.24-2.08) compared with non-Hispanic White identification and socioeconomic disadvantage (OR 1.43 Q4 vs Q1, CI 1.12-1.83) increased the odds.
Conclusions:
Our reported delayed diagnosis rate is greater than recent literature, highlighting the need to consider visits that occur across different health care settings. We further identify sociodemographic factors, including socioeconomic status, that impact a child's risk of delayed diagnosis and perforation.
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