Association of Neighborhood Socioeconomic Disadvantage With Complicated Appendicitis in Children

Bodnar, Catherine; Buss, Radek; Somers, Kimberly K.; Mokdad, Ali H.; Arendonk, Kyle J. Van

doi:10.1016/j.jss.2021.03.036

Cited by 14 publications

(5 citation statements)

References 32 publications

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“…The risk of perforation within 24 h of the onset of symptoms is substantial (7.7%), and it increases in a linear fashion with duration, especially with prehospital delay, moreso than with admitted children [ 52 ]. Socioeconomic factors, which are globally worsened by ongoing COVID-19 pandemic, are also important factor in delayed presentation of pediatric patients as seeking medical care is dependent upon parents’ knowledge of illness, transportation options, insurance status, and financial wellbeing [ 53 , 54 ]. Another reason for higher incidence of complicated appendicitis in young patients is misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

et al. 2022

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Background: The Coronavirus Disease 2019 (COVID-19) pandemic has impacted volume, management strategies and patient outcomes of acute appendicitis. The aim of this systematic review and meta-analysis was to evaluate whether the COVID-19 pandemic resulted in higher incidence of complicated appendicitis in children presenting with acute appendicitis compared to the pre-COVID-19 period. The secondary aim was to investigate the proportion of the patients treated by non-operative management (NOM). Methods: A systematic search of four scientific databases was performed. The search terms used were (coronavirus OR SARS-CoV-2 OR COVID-19 OR novel coronavirus) AND (appendicitis). The inclusion criteria were all patients aged <18 years and diagnosed with acute appendicitis during the COVID-19 and pre-COVID-19 periods. The proportion of children presenting with complicated appendicitis and the proportion of children managed by NOM was compared between the two groups. The Downs and Black scale was used for methodological quality assessment. Results: The present meta-analysis included thirteen studies (twelve retrospective studies and one cross-sectional study). A total of 2782 patients (1239 during the COVID-19 period) were included. A significantly higher incidence of complicated appendicitis (RR = 1.63, 95% CI 1.33–2.01, p < 0.00001) and a significantly higher proportion of children managed via the NOM (RR = 1.95, 95% CI 1.45–2.61, p < 0.00001) was observed in patients during the COVID-19 pandemic when compared to the pre-COVID-19 period. Conclusion: There is a significantly higher incidence of complicated appendicitis in children during the COVID-19 pandemic than in the pre-COVID-19 period. Additionally, a significantly higher proportion of children was managed via the NOM during the pandemic in comparison to the pre-pandemic period.

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Section: Discussionmentioning

confidence: 99%

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

et al. 2022

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“…The third theme focuses on delays in care that can result from delayed diagnosis or misdiagnosis of appendicitis. Cases of misdiagnosis have been studied and are clearly associated with higher perforation rates 8,20 . Despite this, little is known regarding the role of misdiagnosis in explaining inequities in perforation rates.…”

Section: Discussionmentioning

confidence: 99%

“…Cases of misdiagnosis have been studied and are clearly associated with higher perforation rates. 8,20 Despite this, little is known regarding the role of misdiagnosis in explaining inequities in perforation rates. There is some evidence that Black children may have higher rates of misdiagnosis compared to White children, which could contribute to observed racial inequities in perforation, 3,21 but further research is necessary.…”

Section: Theme 4: Receiving Definitive Treatmentmentioning

confidence: 99%

“…1 The impact of SDOH, including the harmful effects of racism, are particularly profound for individuals and families identifying as a member of a historically marginalised racial or ethnic group, and for those living in poverty. For example, appendicitis perforation rates are higher among Black and Latino children, [2][3][4][5][6][7] those who speak a primary language other than English, 4 among publicly insured children 3,5,6,[8][9][10][11] and for those living in disadvantaged neighbourhoods. 5,8,11,12 Delays in care may contribute to higher perforation rates [13][14][15] and lead to higher morbidity.…”

mentioning

confidence: 99%

“…For example, appendicitis perforation rates are higher among Black and Latino children, [2][3][4][5][6][7] those who speak a primary language other than English, 4 among publicly insured children 3,5,6,[8][9][10][11] and for those living in disadvantaged neighbourhoods. 5,8,11,12 Delays in care may contribute to higher perforation rates [13][14][15] and lead to higher morbidity. 2 Factors causing delays may also act as potential drivers for inequities in perforated appendicitis, yet there is very limited qualitative evidence exploring potential causes for delays in care.…”

mentioning

confidence: 99%

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Potential causes of delays in paediatric perforated appendicitis: A prospective interview study

Trinidad,

Parrado,

Hoang

et al. 2024

J Paediatrics Child Health

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AimDelays in care may be a driver of inequities in perforated appendicitis rates. The goal of this study was to explore potential causes of delay in care for children with perforated appendicitis.MethodsWe conducted an interview study of caregivers of children admitted with perforated appendicitis to a children's hospital between December 2022 and March 2023. Semi‐structured interviews based on an iteratively revised interview guide were conducted in‐person during the child's admission. All interviews were transcribed, coded and underwent a process of thematic analysis.ResultsWe reached thematic saturation after 12 interviews. The median age for children was 13.5 years, 50% were male, 83% of caregivers self‐identified as White, and one interview required an interpreter. Through thematic analysis, four major themes for potential causes of delay emerged. The first theme of symptom recognition includes delays related to recognising the symptoms, their severity and the need for medical evaluation. The second theme – accessing care – describes delays that occur after a decision was made to seek care until the child was evaluated. The third theme includes delays that occur in making the diagnosis after evaluation. The last theme captures potential delays in definitive treatment after a diagnosis of appendicitis is made.ConclusionWe identify four major themes from the patient and family perspective, each with multiple sub‐themes, for potential delays in definitive care for children with perforated appendicitis. Additional research is needed to further characterise these potential delays and quantify their role in contributing to inequities in perforation rates.

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Same-day discharge after appendectomy for uncomplicated appendicitis in children: Potential barriers to increased utilization

Buss

Bodnar

Somers³

et al. 2022

The American Journal of Surgery

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Association of Neighborhood Socioeconomic Disadvantage With Complicated Appendicitis in Children

Cited by 14 publications

References 32 publications

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

Potential causes of delays in paediatric perforated appendicitis: A prospective interview study

Same-day discharge after appendectomy for uncomplicated appendicitis in children: Potential barriers to increased utilization

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