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Health Care Utilization and Pediatric Appendicitis: Insights From an Integrated Health System.
Emily Kragel1, Saptati Bhattacharjee1, Morah Brown2
1Kaiser Permanente Oakland Pediatrics Residency Program, Oakland, CA, USA.
The Permanente Journal
|July 7, 2026
Summary
Children in more deprived neighborhoods face higher risks of complicated appendicitis. Improving healthcare delivery between initial visits and hospitalization can reduce diagnosis delays and health disparities.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Socioeconomic Determinants of Health
Background:
- Health disparities in pediatric appendicitis severity correlate with healthcare utilization.
- Neighborhood deprivation is a key factor influencing diagnosis time and outcomes.
- Understanding these factors can guide interventions to improve pediatric appendicitis care.
Purpose of the Study:
- To compare appendicitis outcomes and healthcare utilization by neighborhood deprivation index.
- To identify factors influencing time to diagnosis and severity in pediatric appendicitis.
- To pinpoint areas for intervention within an integrated healthcare system.
Main Methods:
- Retrospective cohort study of 1138 pediatric patients undergoing appendectomy (Jan 2022 - June 2023).
- Neighborhood deprivation categorized into less deprived (quintiles 1-3) and more deprived (quintiles 4-5).
- Primary outcomes: complicated appendicitis, length of stay, 30-day readmission; secondary: prehospital care utilization.
Main Results:
- Patients from more deprived neighborhoods had higher odds of complicated appendicitis (aOR 1.6).
- Prehospital care utilization was higher in more deprived areas (15% vs 11%).
- Longer time to hospitalization and non-office prehospital encounters (ED, virtual care) were linked to complicated appendicitis.
Conclusions:
- Modifiable healthcare delivery factors between initial encounters and hospitalization are critical.
- Interventions targeting these factors can improve timely diagnosis.
- Reducing disparities in pediatric appendicitis requires addressing socioeconomic and care delivery elements.
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