Health Outcomes in US Children with Abdominal Pain at Major Emergency Departments Associated with Race and Socioeconomic Status

Abstract

ObjectiveOver 9.6 million ED visits occur annually for abdominal pain in the US, but little is known about the medical outcomes of these patients based on demographics. We aimed to identify disparities in outcomes among children presenting to the ED with abdominal pain linked to race and SES.MethodsData from 4.2 million pediatric encounters of abdominal pain were analyzed from 43 tertiary US children’s hospitals, including 2.0 million encounters in the emergency department during 2004-2011. Abdominal pain was categorized as functional or organic abdominal pain. Appendicitis (with and without perforation) was used as a surrogate for abdominal pain requiring emergent care. Multivariate analysis estimated likelihood of hospitalizations, radiologic imaging, ICU admissions, appendicitis, appendicitis with perforation, and time to surgery and hospital discharge.ResultsBlack and low income children had increased odds of perforated appendicitis (aOR, 1.42, 95% CI, 1.32- 1.53; aOR, 1.20, 95% CI 1.14 – 1.25). Blacks had increased odds of an ICU admission (aOR, 1.92, 95% CI 1.53 - 2.42) and longer lengths of stay (aHR, 0.91, 95% CI 0.86 – 0.96) than Whites. Minorities and low income also had lower rates of imaging for their appendicitis, including CT scans. The combined effect of race and income on perforated appendicitis, hospitalization, and time to surgery was greater than either separately.ConclusionsBased on race and SES, disparity of health outcomes exists in the acute ED setting among children presenting with abdominal pain, with differences in appendicitis with perforation, length of stay, and time until surgery.

The Effect of Limited English Proficiency on Pediatric Hospital Readmissions

“…We hypothesized that the effect of LEP on pediatric hospital readmissions may have strata-specific variation, as seen in previous studies. 21,35,36 We tested for interactions between our outcome variables and age, income quintile, race/ethnicity, weighted APR-DRG SOI score, CCC, LOS, and surgical/medical admission by including interaction terms one at a time in separate adjusted models. Variables to test for interaction were determined a priori.…”

Executive Summary: The 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps

“…Disparities in health outcomes are driven by many determinants. Many of the factors associated with these differences are sociodemographic, such as race and ethnicity, poverty, education, and geographic location, and are associated with clinically relevant differences in outcomes for many of the conditions seen in the ED: rates of appendicitis with perforation, time to surgery in patients with appendicitis, analgesia for painful conditions, use of antibiotic in presumed viral illnesses, and rates of ED aftercare compliance …”

A Retrospective Evaluation of Patients Presenting to a Pediatric Emergency Department with the Complaint of Pain

“…Acil servislere çok sayıda çocuk hasta karın ağrısı, [20][21][22][23] baş ağrısı, [24][25][26][27][28] göğüs ağrısı, [29][30][31][32][33] kas-iskelet sistemi ağrısı [34][35] gibi yakınmalarla başvurmaktadır. Ağrıya yaklaşımda yaş, cinsiyet, altta yatan hastalıklar gibi pek çok etken yol gösterici olmaktadır.…”

“…40,41 Karın ağrısı çocukluk çağında en sık görülen şikayetlerden biridir ve acil serviste hızlı tanı ve tedavi gerektiren bir durumdur. [20][21] Çalışmamızda ağrı nedeniyle çocuk acil servisine başvuruların %77,5'ini karın ağrısı oluşturmaktadır. Çocuk acil servisine karın ağrısı nedeniyle başvuran çocukların %63,4'ünün kız çocuğu olduğu, başvuranların %24'ünün ise 0-4 yaş arası kız çocuğu olduğu saptanmıştır.…”

“…Çocuk acil servisine karın ağrısı nedeniyle başvuran çocukların %63,4'ünün kız çocuğu olduğu, başvuranların %24'ünün ise 0-4 yaş arası kız çocuğu olduğu saptanmıştır. Çalışmamız ile uyumlu olarak yapılan çalışmalarda da karın ağrısı şikayeti ile çocuk acil servisine başvuran hastaların çoğunluğunun kız çocuğu 20-23 ve 5 yaş altında olduğu 21,22 görülmektedir.…”