Pediatrician Availability Favors Earlier Detection of Appendicitis

Children in areas with an adequate number of pediatricians may get more appropriate care of appendicitis and therefore be at lower risk of a rupture, according to a new study.

Researchers at the Johns Hopkins University School of Medicine (Baltimore, MD, USA) conducted a retrospective database analysis to examine whether density of providers or health care facility factors have a significant effect on the rates of perforated appendicitis in the pediatric population. The data were extracted from the US National Inpatient Sample database and the Kids' Inpatient database between 1988 and 2005. All patients included in the study had an age at admission of younger than 18 years, and had either a perforated appendicitis or acute appendicitis. The main outcome measure was odds ratio of perforated appendicitis to acute appendicitis by county-level density of provider and health care facility factors.

The results showed that increasing geographic density of pediatricians was associated with a decreasing trend in the odds ratio of perforated appendicitis, with a statistically significant protective effect observed in the highest-density quartile of pediatricians, representing a 12% lower risk of rupture than in children in areas with the lowest density of pediatricians. The density of all other provider and health care facility factors analyzed did not demonstrate a significant association with the rates of perforated appendicitis. According to the researchers, the number of pediatricians in the area may be even more vital than the supply of surgeons. The study was published early online on December 20, 2010, in the Archives of Surgery.

"These findings suggest that the specific locality or density of surgeons is not as important as the first line of defense - pediatricians,” said senior author Fizan Abdullah, MD, PhD, of the division of pediatric surgery. "The findings could be applied to a range of conditions, including other abdominal ailments, as well as tumors and traumatic injuries. The implications in terms of the health care system and how it manages patients with surgical disease is striking.”

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