The impact of delay and prehospital factors on acute appendicitis severity in New Zealand children: a national prospective cohort study

Author:

Elliott Brodie M.12ORCID,Bissett Ian P.23ORCID,Harmston Christopher12ORCID,

Affiliation:

1. Department of General Surgery Whangarei Hospital, Northland Whangarei New Zealand

2. Department of Surgery University of Auckland Auckland New Zealand

3. Department of General Surgery Auckland Hospital Auckland New Zealand

Abstract

AbstractBackgroundAppendicitis is the most common reason children undergo acute general surgery but international, population‐level disparities exist. This is hypothesised to be caused by preoperative delay and differential access to surgical care. The impact of prehospital factors on paediatric appendicitis severity in New Zealand is unknown.MethodsA prospective, multicentre cohort study with nested parental questionnaire was conducted by a national trainee‐led collaborative group. Across 14 participating hospitals, 264 patients aged ≤16 years admitted between January and June 2020 with suspected appendicitis were screened. The primary outcome was the effect of prehospital factors on the American Association for the Surgery of Trauma (AAST) anatomical severity grade.ResultsOverall, 182 children had confirmed appendicitis with a median age of 11.6. The rate of complicated appendicitis rate was 38.5% but was significantly higher in rural (44.1%) and Māori children (54.8%). Complicated appendicitis was associated with increased prehospital delay (47.8 h versus 20.1 h; P < 0.001), but not in‐hospital delay (11.3 h versus 13.3 h; P = 0.96). Multivariate analysis revealed increased anatomical severity in rural (OR 4.33, 95% CI 1.78–7.25; P < 0.001), and Māori children (OR 2.39, 95% CI 1.24–5.75; P = 0.019), as well as in families relying on external travel sources or reporting unfamiliarity with appendicitis symptomology.ConclusionPrehospital delay and differential access to prehospital determinants of health are associated with increased severity of paediatric appendicitis. This manifested as increased severity of appendicitis in rural and Māori children. Understanding the pre‐hospital factors that influence the timing of presentation can better inform health‐system improvements.

Funder

Auckland Medical Research Foundation

Publisher

Wiley

Subject

General Medicine,Surgery

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3