10 research outputs found
Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access
BACKGROUND: The U.S. National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare. The Report is a work in progress and includes few indicators specific to children. An indicator worthy of consideration is racial/ethnic differences in the rate of bad outcomes for pediatric acute appendicitis. Bad outcomes for this condition are indicative of poor access to healthcare, which is amenable to social and healthcare policy changes. METHODS: We analyzed the KID Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children. We ran weighted logistic regression models to obtain national estimates of relative odds of rupture rate for the four groups, adjusted for developmental, biological, socioeconomic, health services and hospital factors that might influence disease outcome. RESULTS: Rupture was a much more burdensome outcome than timely surgery and rupture avoidance. Rupture cases had 97% higher hospital charges and 175% longer hospital stays than non-rupture cases on average. These burdens disproportionately affected minority children, who had 24% – 38% higher odds of appendicitis rupture than white children, adjusting for age and gender. These differences were reduced, but remained significant after adjusting for other factors. CONCLUSION: The racial/ethnic disparities in pediatric appendicitis outcome are large and are preventable with timely diagnosis and surgery for all children. Furthermore, estimating this disparity using the KID survey is a relatively straightforward process. Therefore pediatric appendicitis rupture rate is a good candidate for inclusion in the National Healthcare Disparities Report. As with most other health and healthcare disparities, efforts to reduce disparities in income, wealth and access to care will most likely improve the odds of favorable outcome for this condition as well
Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature
Background: Ultrasound is a widely used technique in the diagnosis of acute appendicitis; nevertheless, its
utilization still remains controversial.
Methods: The accuracy of the Ultrasound technique in the diagnosis of acute appendicitis in the adult patient, as
shown in the literature, was searched for.
Results: The gold standard for the diagnosis of appendicitis still remains pathologic confirmation after
appendectomy. In the published literature, graded-compression Ultrasound has shown an extremely variable
diagnostic accuracy in the diagnosis of acute appendicitis (sensitivity range from 44% to 100%; specificity range
from 47% to 99% ). This is due to many reasons, including lack of operator skill, increased bowel gas content,
obesity, anatomic variants, and limitations to explore patients with previuos laparotomies.
Conclusions: Graded-compression Ultrasound still remains our first-line method in patients referred with clinically
suspected acute appendicitis: nevertheless, due to variable diagnostic accuracy, individual skill is requested not only
to perform a successful exam, but also in order to triage those equivocal cases that, subsequently, will have to
undergo assessment by means of Computed Tomography