Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children?

David N. Linz, Ellen E. Hrabovsky, Dido Franceschi, Michael W L Gauderer

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

To determine whether the current "gatekeeper" controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a 10-year period. One hundred seven consecutive children 18 years and younger operated on for acute appendicitis from July 1, 1988 to June 30, 1990 were compared with 119 children with the same diagnosis from July 1, 1978 to June 30, 1980. Age, sex, race, antecedent illnesses, initial physician contact and diagnosis, time to referral and operation, pathology, morbidity, and length of stay were reviewed. The two groups were comparable in terms of age, sex, race, antecedent illnesses, and negative appendectomy rate. More patients in the recent group were initially seen in an emergency room or urgent care setting than in the previous group (62.2% v 48.5%, P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (P = .05). No change existed between the groups in the time to a physician; however, a significant (P = .04) difference existed in the time to surgeon (41.2 hours in the earlier group v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3% v 6.5%, P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends.

Original languageEnglish
Pages (from-to)321-328
Number of pages8
JournalJournal of Pediatric Surgery
Volume28
Issue number3
DOIs
StatePublished - Jan 1 1993
Externally publishedYes

Fingerprint

Appendicitis
Morbidity
Delivery of Health Care
Mortality
Physicians
Length of Stay
Referral and Consultation
Pathology
Appendectomy
Emergency Medical Services
Ambulatory Care
Diagnostic Errors
Hospital Emergency Service
Logistic Models
Pediatrics
Education
Surgeons

Keywords

  • Appendicitis
  • children

ASJC Scopus subject areas

  • Surgery

Cite this

Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children? / Linz, David N.; Hrabovsky, Ellen E.; Franceschi, Dido; Gauderer, Michael W L.

In: Journal of Pediatric Surgery, Vol. 28, No. 3, 01.01.1993, p. 321-328.

Research output: Contribution to journalArticle

@article{16a81143fe014dc3b8cef15109c314b3,
title = "Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children?",
abstract = "To determine whether the current {"}gatekeeper{"} controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a 10-year period. One hundred seven consecutive children 18 years and younger operated on for acute appendicitis from July 1, 1988 to June 30, 1990 were compared with 119 children with the same diagnosis from July 1, 1978 to June 30, 1980. Age, sex, race, antecedent illnesses, initial physician contact and diagnosis, time to referral and operation, pathology, morbidity, and length of stay were reviewed. The two groups were comparable in terms of age, sex, race, antecedent illnesses, and negative appendectomy rate. More patients in the recent group were initially seen in an emergency room or urgent care setting than in the previous group (62.2{\%} v 48.5{\%}, P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (P = .05). No change existed between the groups in the time to a physician; however, a significant (P = .04) difference existed in the time to surgeon (41.2 hours in the earlier group v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3{\%} v 6.5{\%}, P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends.",
keywords = "Appendicitis, children",
author = "Linz, {David N.} and Hrabovsky, {Ellen E.} and Dido Franceschi and Gauderer, {Michael W L}",
year = "1993",
month = "1",
day = "1",
doi = "10.1016/0022-3468(93)90225-A",
language = "English",
volume = "28",
pages = "321--328",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children?

AU - Linz, David N.

AU - Hrabovsky, Ellen E.

AU - Franceschi, Dido

AU - Gauderer, Michael W L

PY - 1993/1/1

Y1 - 1993/1/1

N2 - To determine whether the current "gatekeeper" controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a 10-year period. One hundred seven consecutive children 18 years and younger operated on for acute appendicitis from July 1, 1988 to June 30, 1990 were compared with 119 children with the same diagnosis from July 1, 1978 to June 30, 1980. Age, sex, race, antecedent illnesses, initial physician contact and diagnosis, time to referral and operation, pathology, morbidity, and length of stay were reviewed. The two groups were comparable in terms of age, sex, race, antecedent illnesses, and negative appendectomy rate. More patients in the recent group were initially seen in an emergency room or urgent care setting than in the previous group (62.2% v 48.5%, P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (P = .05). No change existed between the groups in the time to a physician; however, a significant (P = .04) difference existed in the time to surgeon (41.2 hours in the earlier group v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3% v 6.5%, P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends.

AB - To determine whether the current "gatekeeper" controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a 10-year period. One hundred seven consecutive children 18 years and younger operated on for acute appendicitis from July 1, 1988 to June 30, 1990 were compared with 119 children with the same diagnosis from July 1, 1978 to June 30, 1980. Age, sex, race, antecedent illnesses, initial physician contact and diagnosis, time to referral and operation, pathology, morbidity, and length of stay were reviewed. The two groups were comparable in terms of age, sex, race, antecedent illnesses, and negative appendectomy rate. More patients in the recent group were initially seen in an emergency room or urgent care setting than in the previous group (62.2% v 48.5%, P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (P = .05). No change existed between the groups in the time to a physician; however, a significant (P = .04) difference existed in the time to surgeon (41.2 hours in the earlier group v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3% v 6.5%, P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends.

KW - Appendicitis

KW - children

UR - http://www.scopus.com/inward/record.url?scp=0027530025&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027530025&partnerID=8YFLogxK

U2 - 10.1016/0022-3468(93)90225-A

DO - 10.1016/0022-3468(93)90225-A

M3 - Article

C2 - 8468640

AN - SCOPUS:0027530025

VL - 28

SP - 321

EP - 328

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 3

ER -