Disparities in Ultrasound Use for Diagnosing Pediatric Appendicitis Across United States Emergency Departments.
J Surg Res
; 294: 16-25, 2024 02.
Article
in En
| MEDLINE
| ID: mdl-37857139
ABSTRACT
INTRODUCTION:
An ultrasound (US)-first approach for evaluating appendicitis is recommended by the American College of Radiology. We sought to assess the access to and utilization of an US-first approach for children with acute appendicitis in United States Emergency Departments.METHODS:
Utilizing the 2019 Nationwide Emergency Department Sample, we performed a retrospective cohort study of patients <18 y with a primary diagnosis of acute appendicitis based on International Classification of Disease 10th Edition Diagnosis codes. Our primary outcome was the presentation to a hospital that does not perform US for children with acute appendicitis. Our secondary outcome was the receipt of a US at US-capable hospital. We developed generalized linear models with inverse-probability weighting to determine the association between patient characteristics and outcomes.RESULTS:
Of 49,703 total children, 24,102 (48%) received a US evaluation. The odds of presenting at a hospital with no US use were significantly higher for patients aged 11-17 compared to patients <6 y (adjusted odds ratio [aOR] [95% confidence interval (CI)] 1.59, [1.19- 2.13], P = 0.002); lowest median household income quartile compared to highest (aOR [95% CI] 2.50, [1.52-4.10], P < 0.001); rural locations compared to metropolitan (aOR [95% CI] 8.36 [5.54-12.6], P < 0.001), and Hispanic compared to non-Hispanic White (aOR [95% CI] 0.63 [0.45-0.90], P = 0.01). The odds of receiving a US at US-capable hospitals were significantly lower for patients >6 y, lowest median household income quartiles, and rural locations (P < 0.05).CONCLUSIONS:
Rural, older, and poorer children are more likely to present to hospitals that do not utilize US in the diagnosis of acute appendicitis and are less likely to undergo US at US-capable hospitals.Key words
Full text:
1
Collection:
01-internacional
Health context:
1_ASSA2030
/
2_ODS3
Database:
MEDLINE
Main subject:
Appendicitis
/
Ultrasonography
/
Emergency Service, Hospital
/
Healthcare Disparities
Limits:
Adolescent
/
Child
/
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
J Surg Res
Year:
2024
Document type:
Article