AEM Early Access 53: Racial and Ethnic Disparities in the Delayed Diagnosis of Appendicitis Among Children

Welcome to the fifty-third episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to a recent AEM Article or Article in Press, with an author interview podcast.

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DISCUSSING (open access through October 1, 2021; click title to access):

Racial and Ethnic Disparities in the Delayed Diagnosis of Appendicitis Among Children

Monika K. Goyal MD, MSCE, James M. Chamberlain MD, Michael Webb MS, Robert W. Grundmeier MD, Tiffani J. Johnson MD, MS, Scott A. Lorch MD, MSCE, Joseph J. Zorc MD, MSCE, Evaline Alessandrini MD, MSCE, Lalit Bajaj MD, MPH, Lawrence Cook PhD, Elizabeth R. Alpern MD, MSCE,for the Pediatric Emergency Care Applied Research Network (PECARN)

LISTEN NOW: INTERVIEW WITH AUTHOR

Monika Goyal MD, MSCE

Associate Division Chief, Director of Academic Affairs & Research

Associate Professor of Pediatrics & Emergency Medicine

Division of Emergency Medicine

Children's National Hospital

The George Washington University

Abstract

Background

Appendicitis is the most common surgical condition in pediatric emergency department (ED) patients. Prompt diagnosis can reduce morbidity, including appendiceal perforation. The goal of this study was to measure racial/ethnic differences in rates of 1) appendiceal perforation, 2) delayed diagnosis of appendicitis, and 3) diagnostic imaging during prior visit(s).

Methods

This was a 3-year multicenter (seven EDs) retrospective cohort study of children diagnosed with appendicitis using the Pediatric Emergency Care Applied Research Network Registry. Delayed diagnosis was defined as having at least one prior ED visit within 7 days preceding appendicitis diagnosis. We performed multivariable logistic regression to measure associations of race/ethnicity (non-Hispanic [NH]-white, NH-Black, Hispanic, other) with 1) appendiceal perforation, 2) delayed diagnosis of appendicitis, and 3) diagnostic imaging during prior visit(s).

Results

Of 7,298 patients with appendicitis and documented race/ethnicity, 2,567 (35.2%) had appendiceal perforation. In comparison to NH-whites, NH-Black children had higher likelihood of perforation (36.5% vs. 34.9%; adjusted odds ratio [aOR] = 1.21 [95% confidence interval {CI} = 1.01 to 1.45]). A total of 206 (2.8%) had a delayed diagnosis of appendicitis. NH-Black children were more likely to have delayed diagnoses (4.7% vs. 2.0%; aOR = 1.81 [95% CI = 1.09 to 2.98]). Eighty-nine (43.2%) patients with delayed diagnosis had abdominal imaging during their prior visits. In comparison to NH-whites, NH-Black children were less likely to undergo any imaging (28.2% vs. 46.2%; aOR = 0.41 [95% CI = 0.18 to 0.96]) or definitive imaging (e.g., ultrasound/computed tomography/magnetic resonance imaging; 10.3% vs. 35.9%; aOR = 0.15 [95% CI = 0.05 to 0.50]) during prior visits.

Conclusions

In this multicenter cohort, there were racial disparities in appendiceal perforation. There were also racial disparities in rates of delayed diagnosis of appendicitis and diagnostic imaging during prior ED visits. These disparities in diagnostic imaging may lead to delays in appendicitis diagnosis and, thus, may contribute to higher perforation rates demonstrated among minority children.