Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. 920-925 (doi:10.1542/peds.2004-1363)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (21) Citing Articles via Google Scholar Google Scholar Articles by Smink, D. S. Articles by Finkelstein, J. A. Search for Related Content PubMed PubMed Citation Articles by Smink, D. S. Articles by Finkelstein, J. A. Related Collections Surgery Social Bookmarking                         What's this?

Effects of Race, Insurance Status, and Hospital Volume on Perforated Appendicitis in Children

Douglas S. Smink, MD, MPH^*,,, Steven J. Fishman, MD^*, Ken Kleinman, ScD^||, Jonathan A. Finkelstein, MD, MPH^,||,¶

^* Department of Surgery
Harvard Pediatric Health Services Research Fellowship
^¶ Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
^|| Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts

Objective. Previous research suggests that perforated appendicitis is more common in Medicaid patients, but the roles of minority race and hospital volume remain largely unstudied. We sought to investigate the association of perforated appendicitis in children with minority race, insurance status, and hospital volume.

Methods. We conducted a retrospective, population-based cohort study of 33184 children who had an International Classification of Diseases, Ninth Revision diagnosis code for acute appendicitis in The Kids' Inpatient Database, a pediatric database from 22 states in 1997. A multivariate logistic regression model was developed to determine patient and hospital characteristics predictive of perforated appendicitis.

Results. Of 33184 children with acute appendicitis, 10777 (32.5%) were perforated. In multivariate analysis, black (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 1.10–1.39) and Hispanic (OR: 1.19; 95% CI: 1.10–1.29) children were more likely to have perforated appendicitis than white children. Perforation was also more likely in Medicaid patients (OR: 1.30; 95% CI 1.22–1.39) compared with privately insured children. Annual hospital volume of cases of appendicitis was not significantly associated with perforation in multivariate analysis.

Conclusions. Perforated appendicitis disproportionately affected both children of minority race and children insured by Medicaid. No effect of hospital volume was observed. To reduce this racial disparity, efforts should focus on the causes of delayed diagnosis and the treatment of appendicitis in children of minority race.

---

Key Words: appendicitis • perforation • race • outcome

Abbreviations: KID, Kids' Inpatient Database • LOS, length of stay • OR, odds ratio • CI, confidence interval

---

Accepted Aug 30, 2004.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. A. Sosa, C. T. Tuggle, T. S. Wang, D. C. Thomas, L. Boudourakis, S. Rivkees, and S. A. Roman Clinical and Economic Outcomes of Thyroid and Parathyroid Surgery in Children J. Clin. Endocrinol. Metab., August 1, 2008; 93(8): 3058 - 3065. [Abstract] [Full Text] [PDF]

				K. M. McDonald, S. M. Davies, C. A. Haberland, J. J. Geppert, A. Ku, and P. S. Romano Preliminary Assessment of Pediatric Health Care Quality and Patient Safety in the United States Using Readily Available Administrative Data Pediatrics, August 1, 2008; 122(2): e416 - e425. [Abstract] [Full Text] [PDF]

				H. G. Herrod and C. F. Chang Potentially Avoidable Pediatric Hospitalizations as Defined by the Agency for Healthcare Research and Quality: What Do They Tell Us About Disparities in Child Health? Clinical Pediatrics, March 1, 2008; 47(2): 128 - 136. [Abstract] [PDF]

				D. G. Bundy, J. S. Byerley, E. A. Liles, E. M. Perrin, J. Katznelson, and H. E. Rice Does This Child Have Appendicitis? JAMA, July 25, 2007; 298(4): 438 - 451. [Abstract] [Full Text] [PDF]

				J. Todd, C. Armon, A. Griggs, S. Poole, and S. Berman Increased Rates of Morbidity, Mortality, and Charges for Hospitalized Children With Public or No Health Insurance as Compared With Children With Private Insurance in Colorado and the United States Pediatrics, August 1, 2006; 118(2): 577 - 585. [Abstract] [Full Text] [PDF]

				B. C. Nwomeh, D. J. Chisolm, D. A. Caniano, and K. J. Kelleher Racial and Socioeconomic Disparity in Perforated Appendicitis Among Children: Where Is the Problem? Pediatrics, March 1, 2006; 117(3): 870 - 875. [Abstract] [Full Text] [PDF]

				Perforated Appendicitis Is More Common in Minority Children Journal Watch Emergency Medicine, May 11, 2005; 2005(511): 4 - 4. [Full Text]

				S. Berman Challenge of Transforming Our Private and Public Pediatric Health Care Systems to Emphasize Value Pediatrics, April 1, 2005; 115(4): 1068 - 1070. [Full Text] [PDF]