Department of Radiology
University of Wisconsin School of Medicine and Public Health

Goyal 2021

 

Year: 2021

Title: Racial and ethnic disparities in the delayed diagnosis of appendicitis among children

Country: United States

Age: Pediatric Only

Sex: All Sexes

Population: Multiple Groups

Care Setting: Emergency Department

Clinical Setting: GI/Abdominal

Data Level: Multi-Institution

Data Type: Government Survey

Data Source: Pediatric Emergency Care Applied Research Network Registry

Conclusion: Disparities In Some Minority Groups

Health OutComes Reported: Yes

Mitigation: No

Free Text Conclusion: NH-Black children had a higher likelihood of perforation, and a lower likelihood of undergoing any imaging or definitive imaging during prior visits.

Abstract: BACKGROUND: Appendicitis is the most common surgical condition in pediatric emergency department (ED) patients. Prompt diagnosis can reduce morbidity, including appendiceal perforation. The goal of this study was to measure racial/ethnic differences in rates of 1) appendiceal perforation, 2) delayed diagnosis of appendicitis, and 3) diagnostic imaging during prior visit(s). METHODS: This was a 3-year multicenter (seven EDs) retrospective cohort study of children diagnosed with appendicitis using the Pediatric Emergency Care Applied Research Network Registry. Delayed diagnosis was defined as having at least one prior ED visit within 7 days preceding appendicitis diagnosis. We performed multivariable logistic regression to measure associations of race/ethnicity (non-Hispanic [NH]-white, NH-Black, Hispanic, other) with 1) appendiceal perforation, 2) delayed diagnosis of appendicitis, and 3) diagnostic imaging during prior visit(s). RESULTS: Of 7,298 patients with appendicitis and documented race/ethnicity, 2,567 (35.2%) had appendiceal perforation. In comparison to NH-whites, NH-Black children had higher likelihood of perforation (36.5% vs. 34.9%; adjusted odds ratio [aOR]= 1.21 [95% confidence interval {CI}= 1.01 to 1.45]). A total of 206 (2.8%) had a delayed diagnosis of appendicitis. NH-Black children were more likely to have delayed diagnoses (4.7% vs. 2.0%; aOR= 1.81 [95% CI= 1.09 to 2.98]). Eighty-nine (43.2%) patients with delayed diagnosis had abdominal imaging during their prior visits. In comparison to NH-whites, NH-Black children were less likely to undergo any imaging (28.2% vs. 46.2%; aOR= 0.41 [95% CI= 0.18 to 0.96]) or definitive imaging (e.g., ultrasound/ computed tomography/magnetic resonance imaging; 10.3% vs. 35.9%; aOR= 0.15 [95% CI= 0.05 to 0.50]) during prior visits. CONCLUSIONS: In this multicenter cohort, there were racial disparities in appendiceal perforation. There were also racial disparities in rates of delayed diagnosis of appendicitis and diagnostic imaging during prior ED visits. These disparities in diagnostic imaging may lead to delays in appendicitis diagnosis and, thus, may contribute to higher perforation rates demonstrated among minority children.