Graham C Thompson1, Suzanne Schuh2, Jocelyn Gravel3, Sarah Reid4, Eleanor Fitzpatrick5, Troy Turner6, Maala Bhatt2, Darcy Beer7, Geoffrey Blair8, Robin Eccles1, Sarah Jones9, Jennifer Kilgar9, Natalia Liston1, John Martin10, Brent Hagel1,11, Alberto Nettel-Aguirre1,11. 1. Alberta Children's Hospital Research Institute and Department of Pediatrics, University of Calgary, Calgary, AB. 2. Hospital for Sick Children, University of Toronto, Toronto, ON. 3. Centre Hospitalier Universitaire Ste-Justine, Universite de Montreal, Montreal, QC. 4. Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON. 5. IWK Health Centre, Dalhousie University, Halifax, NS. 6. Stollery Children's Hospital, University of Alberta, Edmonton, AB. 7. Winnipeg Children's Hospital, University of Manitoba, Winnipeg, MB. 8. British Columbia Children's Hospital, University of British Columbia, Vancouver, BC. 9. Children's Hospital London Health Sciences Centre, Western University, London, ON. 10. Janeway Children's Health and Rehabilitation Centre, Memorial University, St. John's, NL. 11. Department of Community Health Sciences, University of Calgary, Calgary, AB.
Abstract
OBJECTIVES: The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies. METHODS: Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with after-hours surgery were determined using generalized estimating equations logistic regression. RESULTS: Of the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p < 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p < 0.001), blood cultures (p < 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p < 0.001 and p = 0.001, respectively), as did the type of surgical approach (p < 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014). CONCLUSIONS: Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes.
OBJECTIVES: The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies. METHODS: Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with after-hours surgery were determined using generalized estimating equations logistic regression. RESULTS: Of the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p < 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p < 0.001), blood cultures (p < 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p < 0.001 and p = 0.001, respectively), as did the type of surgical approach (p < 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014). CONCLUSIONS: Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes.
Authors: Nusrat S Shommu; Craig N Jenne; Jaime Blackwood; Dori-Ann Martin; Ari R Joffe; Robin Eccles; Mary Brindle; Ijab Khanafer; Hans J Vogel; Graham C Thompson Journal: Sci Rep Date: 2018-03-06 Impact factor: 4.379
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