Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children?
To determine whether the current “gatekeeper” controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a 10-year period. One hundred seven consecutive children...
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Veröffentlicht in: | Journal of pediatric surgery 1993-03, Vol.28 (3), p.321-328 |
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description | To determine whether the current “gatekeeper” controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a 10-year period. One hundred seven consecutive children 18 years and younger operated on for acute appendicitis from July 1, 1988 to June 30, 1990 were compared with 119 children with the same diagnosis from July 1, 1978 to June 30, 1980. Age, sex, race, antecedent illnesses, initial physician contact and diagnosis, time to referral and operation, pathology, morbidity, and length of stay were reviewed. The two groups were comparable in terms of age, sex, race, antecedent illnesses, and negative appendectomy rate. More patients in the recent group were initially seen in an emergency room or urgent care setting than in the previous group (62.2%
v 48.5%,
P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (
P = .05). No change existed between the groups in the time to a physician; however, a significant (
P = .04) difference existed in the time to surgeon (41.2 hours in the earlier group
v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3%
v 6.5%,
P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends. |
doi_str_mv | 10.1016/0022-3468(93)90225-A |
format | Article |
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v 48.5%,
P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (
P = .05). No change existed between the groups in the time to a physician; however, a significant (
P = .04) difference existed in the time to surgeon (41.2 hours in the earlier group
v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3%
v 6.5%,
P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/0022-3468(93)90225-A</identifier><identifier>PMID: 8468640</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Disease ; Adolescent ; Appendectomy - adverse effects ; Appendectomy - statistics & numerical data ; Appendicitis - diagnosis ; Appendicitis - mortality ; Appendicitis - surgery ; Child ; Child, Preschool ; Delivery of Health Care - trends ; Diagnostic Errors ; Discriminant Analysis ; Emergencies ; Emergency Service, Hospital - statistics & numerical data ; Female ; Hospital Bed Capacity, 500 and over ; Hospital Mortality ; Hospitals, Pediatric - statistics & numerical data ; Humans ; Incidence ; Length of Stay - statistics & numerical data ; Male ; Morbidity ; Ohio ; Postoperative Complications - epidemiology ; Referral and Consultation - statistics & numerical data ; Retrospective Studies ; Time Factors</subject><ispartof>Journal of pediatric surgery, 1993-03, Vol.28 (3), p.321-328</ispartof><rights>1993</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c388t-4f3ce8bc43c931bee466abe1cf776f00470ca779c0e899c205a11d0793031bf53</citedby><cites>FETCH-LOGICAL-c388t-4f3ce8bc43c931bee466abe1cf776f00470ca779c0e899c205a11d0793031bf53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/002234689390225A$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8468640$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Linz, David N.</creatorcontrib><creatorcontrib>Hrabovsky, Ellen E.</creatorcontrib><creatorcontrib>Franceschi, Dido</creatorcontrib><creatorcontrib>Gauderer, Michael W.L.</creatorcontrib><title>Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children?</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>To determine whether the current “gatekeeper” controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a 10-year period. One hundred seven consecutive children 18 years and younger operated on for acute appendicitis from July 1, 1988 to June 30, 1990 were compared with 119 children with the same diagnosis from July 1, 1978 to June 30, 1980. Age, sex, race, antecedent illnesses, initial physician contact and diagnosis, time to referral and operation, pathology, morbidity, and length of stay were reviewed. The two groups were comparable in terms of age, sex, race, antecedent illnesses, and negative appendectomy rate. More patients in the recent group were initially seen in an emergency room or urgent care setting than in the previous group (62.2%
v 48.5%,
P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (
P = .05). No change existed between the groups in the time to a physician; however, a significant (
P = .04) difference existed in the time to surgeon (41.2 hours in the earlier group
v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3%
v 6.5%,
P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends.</description><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Appendectomy - adverse effects</subject><subject>Appendectomy - statistics & numerical data</subject><subject>Appendicitis - diagnosis</subject><subject>Appendicitis - mortality</subject><subject>Appendicitis - surgery</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Delivery of Health Care - trends</subject><subject>Diagnostic Errors</subject><subject>Discriminant Analysis</subject><subject>Emergencies</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Hospital Bed Capacity, 500 and over</subject><subject>Hospital Mortality</subject><subject>Hospitals, Pediatric - statistics & numerical data</subject><subject>Humans</subject><subject>Incidence</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Morbidity</subject><subject>Ohio</subject><subject>Postoperative Complications - epidemiology</subject><subject>Referral and Consultation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUctuFDEQtBBRWAJ_AJJPCA4T7PWMHxeiVXgkUiQucLY8PT1aoxl7sT2RIn4eT3aVI5xaVV3VLVUR8oazS864_MjYdtuIVur3RnwwFXTN7hnZ8E7wpmNCPSebJ8kL8jLnX4xVmvFzcq4rJ1u2IX8-R8y07JHCkhKGQvfoprKn4BJSDPc-xTCvPMRQku-XgrRE6gMkdBkHOsfU-8GXB-rCIypuWlEcqYNV7Q4HDIMHX3yuPgp7Pw311dUrcja6KePr07wgP79--XF909x9_3Z7vbtrQGhdmnYUgLqHVoARvEdspXQ9chiVkiNjrWLglDLAUBsDW9Y5zgemjGBVPnbigrw73j2k-HvBXOzsM-A0uYBxyVZ1UmrViv8KudR625lV2B6FkGLOCUd7SH526cFyZtdy7Jq8XZO3RtjHcuyu2t6e7i_9jMOT6dRG3X867rGmce8x2QweA-DgE0KxQ_T_fvAX6xKgRQ</recordid><startdate>19930301</startdate><enddate>19930301</enddate><creator>Linz, David N.</creator><creator>Hrabovsky, Ellen E.</creator><creator>Franceschi, Dido</creator><creator>Gauderer, Michael W.L.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>19930301</creationdate><title>Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children?</title><author>Linz, David N. ; Hrabovsky, Ellen E. ; Franceschi, Dido ; Gauderer, Michael W.L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c388t-4f3ce8bc43c931bee466abe1cf776f00470ca779c0e899c205a11d0793031bf53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Acute Disease</topic><topic>Adolescent</topic><topic>Appendectomy - adverse effects</topic><topic>Appendectomy - statistics & numerical data</topic><topic>Appendicitis - diagnosis</topic><topic>Appendicitis - mortality</topic><topic>Appendicitis - surgery</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Delivery of Health Care - trends</topic><topic>Diagnostic Errors</topic><topic>Discriminant Analysis</topic><topic>Emergencies</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Hospital Bed Capacity, 500 and over</topic><topic>Hospital Mortality</topic><topic>Hospitals, Pediatric - statistics & numerical data</topic><topic>Humans</topic><topic>Incidence</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Morbidity</topic><topic>Ohio</topic><topic>Postoperative Complications - epidemiology</topic><topic>Referral and Consultation - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Linz, David N.</creatorcontrib><creatorcontrib>Hrabovsky, Ellen E.</creatorcontrib><creatorcontrib>Franceschi, Dido</creatorcontrib><creatorcontrib>Gauderer, Michael W.L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Linz, David N.</au><au>Hrabovsky, Ellen E.</au><au>Franceschi, Dido</au><au>Gauderer, Michael W.L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children?</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>1993-03-01</date><risdate>1993</risdate><volume>28</volume><issue>3</issue><spage>321</spage><epage>328</epage><pages>321-328</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><abstract>To determine whether the current “gatekeeper” controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a 10-year period. One hundred seven consecutive children 18 years and younger operated on for acute appendicitis from July 1, 1988 to June 30, 1990 were compared with 119 children with the same diagnosis from July 1, 1978 to June 30, 1980. Age, sex, race, antecedent illnesses, initial physician contact and diagnosis, time to referral and operation, pathology, morbidity, and length of stay were reviewed. The two groups were comparable in terms of age, sex, race, antecedent illnesses, and negative appendectomy rate. More patients in the recent group were initially seen in an emergency room or urgent care setting than in the previous group (62.2%
v 48.5%,
P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (
P = .05). No change existed between the groups in the time to a physician; however, a significant (
P = .04) difference existed in the time to surgeon (41.2 hours in the earlier group
v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3%
v 6.5%,
P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>8468640</pmid><doi>10.1016/0022-3468(93)90225-A</doi><tpages>8</tpages></addata></record> |
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source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
subjects | Acute Disease Adolescent Appendectomy - adverse effects Appendectomy - statistics & numerical data Appendicitis - diagnosis Appendicitis - mortality Appendicitis - surgery Child Child, Preschool Delivery of Health Care - trends Diagnostic Errors Discriminant Analysis Emergencies Emergency Service, Hospital - statistics & numerical data Female Hospital Bed Capacity, 500 and over Hospital Mortality Hospitals, Pediatric - statistics & numerical data Humans Incidence Length of Stay - statistics & numerical data Male Morbidity Ohio Postoperative Complications - epidemiology Referral and Consultation - statistics & numerical data Retrospective Studies Time Factors |
title | Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children? |
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