Advertisement

Potential barriers associated with increased prevalence of perforated appendicitis in Colorado's pediatric Medicaid population

Published:January 23, 2013DOI:https://doi.org/10.1016/j.ajem.2012.09.009

      Abstract

      Objective

      We sought to identify barriers and delays in care associated with the increased prevalence of perforated appendicitis among Colorado's pediatric Medicaid population.

      Methods

      We conducted a retrospective cohort study of all cases of pediatric appendicitis, which had Colorado Medicaid from 2007 to 2008 using descriptive statistics, bivariate analysis, and multivariable logistic regression.

      Results

      Of the 479 appendicitis cases, 42.6% were perforated. In both the bivariate and multivariate analysis, perforated cases did not significantly differ from nonperforated cases with respect to sex, rurality of residence, or race with the exception of black race in the multivariate model. Perforated cases were more likely to be younger, have been enrolled in Medicaid for less than 6 months, have seen a provider within 5 days of their diagnosis, and have been transferred to another hospital for treatment.

      Conclusions

      The high prevalence of perforated appendicitis in Colorado children with Medicaid coverage is not associated with race or physical proximity to care but may be associated with the duration of Medicaid coverage, which highlights the importance of establishing medical homes to direct patients on where and how to seek care.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Korner H.
        • Sondenaa K.
        • Soreide J.A.
        • et al.
        Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis.
        Word J Surg. 1997; 21: 313-317
        • Brender J.D.
        • Marcuse E.K.
        • Koepsell T.D.
        • et al.
        Childhood appendicitis: factors associated with perforation.
        Pediatrics. 1985; 76: 301-306
        • Cappendijk V.C.
        • Hazebroek F.W.J.
        The impact of diagnostic delay on the course of acute appendicitis.
        Arch Dis Child. 2000; 83: 64-66
        • O'Toole S.J.
        • Karamanoukian H.L.
        • Allen J.E.
        • et al.
        Insurance-related differences in the presentation of pediatric appendicitis.
        J Pediatr Surg. 1996; 31: 1032-1034
        • Bratton S.L.
        • Haberkern C.M.
        • Waldhausen J.H.T.
        Acute appendicitis risks of complications: age and medicaid insurance.
        Pediatrics. 2000; 106: 75-78
        • Gadomski A.
        • Jenkins P.
        Ruptured appendicitis among children as an indicator of access to care.
        Health Serv Res. 2001; 36: 129-142
        • Smink D.S.
        • Fishman S.J.
        • Kleinman K.
        • et al.
        Effects of race, insurance status and hospital volume on perforated appendicitis in children.
        Pediatrics. 2005; 115: 920-925
        • Bravemen P.
        • Schaaf V.M.
        • Egerter S.
        • et al.
        Insurance-related differences in risk of ruptured appendix.
        N Engl J Med. 1994; 331: 444-449
        • Krajewski S.A.
        • Hameed S.M.
        • Smink D.S.
        • et al.
        Access to emergency operative care: a comparative study between the Canadian and American health care systems.
        Surgery. 2009; 146: 300-307
      1. World Health Organization. International Classification of Diseases. Ninth Revision (ICD-9). 2012. Available at: http://www.who.int/classifications/icd/en.

        • Jablonski K.A.
        • Guagliardo M.F.
        Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access.
        Population Health Metrics. 2005; 3: 4
        • Guagliardo M.F.
        • Teach S.J.
        • Huang Z.J.
        • Chamberlain J.M.
        • et al.
        Racial and ethnic disparities in pediatric appendicitis rupture rate.
        Acad Emerg Med. 2003; 10: 1218-1227
        • Ponsky T.A.
        • Huang Z.J.
        • Kittle K.
        • et al.
        Hospital- and patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children.
        JAMA. 2004; 292: 1977-1982
        • Buckley R.G.
        • Distefan J.
        • Gubler K.D.
        • Slymen D.
        The risk of appendiceal rupture based on hospital admission source.
        Acad Emerg Med. 1999; 6: 596-601
        • Kokoska E.R.
        • Bird T.M.
        • Robbins J.M.
        • Smith S.D.
        • et al.
        Racial disparities in the management of pediatric appendicitis.
        J Surg Res. 2007; 137: 83-88