Quality metrics for emergency abdominal surgery in children: a systematic review

Sogbodjor, L. Amaki; Singleton, Georgina; Davenport, Mark; Walker, Suellen M.; Moonesinghe, Ramani

doi:10.1016/j.bja.2021.10.045

Cited by 4 publications

(2 citation statements)

References 87 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In acute appendicitis, racial and ethnic disparities occur in presentation, treatment, and outcomes . In children, delayed diagnosis may account for higher rates of perforation at presentation . In a multicenter study by Goyal et al, non-Hispanic Black children with appendicitis were more likely to have a delayed or missed diagnosis of appendicitis, less likely to undergo any imaging, and more likely to present with perforated appendicitis compared with non-Hispanic White children.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9][10] In children, delayed diagnosis may account for higher rates of perforation at presentation. 7,11 In a multicenter study by Goyal et al, 7 non-Hispanic Black children with appendicitis were more likely to have a delayed or missed diagnosis of appendicitis, less likely to undergo any imaging, and more likely to present with perforated appendicitis compared with non-Hispanic White children. However, in adults, less is known about the effects of delayed diagnosis on acute appendicitis outcomes.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

et al. 2023

View full text Add to dashboard Cite

ImportanceRacial disparities in timely diagnosis and treatment of surgical conditions exist; however, it is poorly understood whether there are hospital structural measures or patient-level characteristics that modify this phenomenon.ObjectiveTo assess whether patient race and ethnicity are associated with delayed appendicitis diagnosis and postoperative 30-day hospital use and whether there are patient- or systems-level factors that modify this association.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used data from the Healthcare Cost and Utilization Project’s state inpatient and emergency department (ED) databases from 4 states (Florida, Maryland, New York, and Wisconsin) for patients aged 18 to 64 years who underwent appendectomy from January 7, 2016, to December 1, 2017. Data were analyzed from January 1, 2016, to December 31, 2017.ExposureDelayed diagnosis of appendicitis, defined as an initial ED presentation with an abdominal diagnosis other than appendicitis followed by re-presentation within a week for appendectomy.Main Outcomes and MeasuresA mixed-effects multivariable Poisson regression model was used to estimate the association of delayed diagnosis of appendicitis with race and ethnicity while controlling for patient and hospital variables. A second mixed-effects multivariable Poisson regression model quantified the association of delayed diagnosis of appendicitis with postoperative 30-day hospital use.ResultsOf 80 312 patients who received an appendectomy during the study period (median age, 38 years [IQR, 27-50 years]; 50.8% female), 2013 (2.5%) experienced delayed diagnosis. In the entire cohort, 2.9% of patients were Asian or Pacific Islander, 18.8% were Hispanic, 10.9% were non-Hispanic Black, 60.8% were non-Hispanic White, and 6.6% were other race and ethnicity; most were privately insured (60.2%). Non-Hispanic Black patients had a 1.41 (95% CI, 1.21-1.63) times higher adjusted rate of delayed diagnosis compared with non-Hispanic White patients. Patients at hospitals with a more than 50% Black or Hispanic population had a 0.73 (95% CI, 0.59-0.91) decreased adjusted rate of delayed appendicitis diagnosis compared with hospitals with a less than 25% Black or Hispanic population. Conversely, patients at hospitals with more than 50% of discharges of Medicaid patients had a 3.51 (95% CI, 1.69-7.28) higher adjusted rate of delayed diagnosis compared with hospitals with less than 10% of discharges of Medicaid patients. Additional factors associated with delayed diagnosis included female sex, higher levels of patient comorbidity, and living in a low-income zip code. Delayed diagnosis was associated with a 1.38 (95% CI, 1.36-1.61) increased adjusted rate of postoperative 30-day hospital use.Conclusions and RelevanceIn this cohort study, non-Hispanic Black patients had higher rates of delayed appendicitis diagnosis and 30-day hospital use than White patients. Patients presenting to hospitals with a greater than 50% Black and Hispanic population were less likely to experience delayed diagnosis, suggesting that seeking care at a hospital that serves a diverse patient population may help mitigate the increased rate of delayed diagnosis observed for non-Hispanic Black patients.

show abstract

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

et al. 2023

View full text Add to dashboard Cite

show abstract

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the published airway management literature has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This second of two articles addresses airway evaluation, decision-making, and safe implementation of an airway management strategy when difficulty is anticipated. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence is lacking, statements are based on group consensus. Findings and key recommendations Prior to airway management, a documented strategy should be formulated for every patient, based on airway evaluation. Bedside examination should seek predictors of difficulty with face-mask ventilation (FMV), tracheal intubation using video- or direct laryngoscopy (VL or DL), supraglottic airway use, as well as emergency front of neck airway access. Patient physiology and contextual issues should also be assessed. Predicted difficulty should prompt careful decision-making on how most safely to proceed with airway management. Awake tracheal intubation may provide an extra margin of safety when impossible VL or DL is predicted, when difficulty is predicted with more than one mode of airway management (e.g., tracheal intubation and FMV), or when predicted difficulty coincides with significant physiologic or contextual issues. If managing the patient after the induction of general anesthesia despite predicted difficulty, team briefing should include triggers for moving from one technique to the next, expert assistance should be sourced, and required equipment should be present. Unanticipated difficulty with airway management can always occur, so the airway manager should have a strategy for difficulty occurring in every patient, and the institution must make difficult airway equipment readily available. Tracheal extubation of the at-risk patient must also be carefully planned, including assessment of the patient’s tolerance for withdrawal of airway support and whether re-intubation might be difficult.

show abstract

Structural indicators of quality care for children undergoing emergency abdominal surgery

Selman

Sogbodjor

Williams

et al. 2023

British Journal of Surgery

View full text Add to dashboard Cite

Quality metrics for emergency abdominal surgery in children: a systematic review

Cited by 4 publications

References 87 publications

Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Structural indicators of quality care for children undergoing emergency abdominal surgery

Contact Info

Product

Resources

About