Emergency Department Volume and Delayed Diagnosis of Pediatric Appendicitis: A Retrospective Cohort Study.

ABSTRACT

OBJECTIVE: To determine the association of emergency department (ED) volume of children and delayed diagnosis of appendicitis. BACKGROUND: Delayed diagnosis of appendicitis is common in children. The association between ED volume and delayed diagnosis is uncertain, but diagnosis-specific experience might improve diagnostic timeliness. METHODS: Using Healthcare Cost and Utilization Project 8-state data from 2014 to 2019, we studied all children with appendicitis <18 years old in all EDs. The main outcome was probable delayed diagnosis >75% likelihood that a delay occurred based on a previously validated measure. Hierarchical models tested associations between ED volumes and delay, adjusting for age, sex, and chronic conditions. We compared complication rates by delayed diagnosis occurrence. RESULTS: Among 93,136 children with appendicitis, 3,293 (3.5%) had delayed diagnosis. Each 2-fold increase in ED volume was associated with a 6.9% (95% CI 2.2, 11.3) decreased odds of delayed diagnosis. Each 2-fold increase in appendicitis volume was associated with a 24.1% (95% CI 21.0, 27.0) decreased odds of delay. Those with delayed diagnosis were more likely to receive intensive care [odds ratio (OR) 1.81, 95% CI 1.48, 2.21], have perforated appendicitis (OR 2.81, 95% CI 2.62, 3.02), undergo abdominal abscess drainage (OR 2.49, 95% CI 2.16, 2.88), have multiple abdominal surgeries (OR 2.56, 95% CI 2.13, 3.07), or develop sepsis (OR 2.02, 95% CI 1.61, 2.54). CONCLUSIONS: Higher ED volumes were associated with a lower risk of delayed diagnosis of pediatric appendicitis. Delay was associated with complications.