• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of hsresearchLink to Publisher's site
Health Serv Res. Apr 2001; 36(1 Pt 1): 129–142.
PMCID: PMC1089219

Ruptured appendicitis among children as an indicator of access to care.

Abstract

OBJECTIVE: To determine factors associated with ruptured appendicitis among children, using administrative databases. Insurance-related differences in the risk of ruptured appendix among adults in California have previously been described (Braveman, Schaaf, Egerter, et al. 1994). DATA SOURCES/STUDY SETTING: State of Maryland Medicaid claims data for children < or = 18 years of age from 1989 to 1993 and hospital discharge data for children < or = 19 years of age from 1989 to 1994 were analyzed. STUDY DESIGN: Administrative data analysis pre- and post-implementation of a Medicaid managed care program called Maryland Access to Care. DATA COLLECTION/EXTRACTION METHODS: Medicaid claims and hospital discharge ICD-9-CM codes were used to define hospitalization for ruptured and nonruptured appendicitis. Linear regression was used to model trends. Logistic regression was used to model the probability of ruptured appendicitis. PRINCIPAL FINDINGS: Among the 374 Medicaid inpatient claims for appendicitis, 37 percent were for ruptured appendicitis. Among the 5,141 hospital discharges for appendicitis, 30 percent were for ruptured appendicitis. Using Medicaid claims data, the probability of ruptured appendicitis was inversely related to age (OR = 0.86, 95% CI 0.81-0.91), white race (OR = 0.35, 95% CI 0.17-0.71) and preventive care visits (OR = 0.19, 95% CI 0.05-0.77). Using hospital discharge data, age (OR = 0.91, 95% CI 0.90-0.93) and female gender (OR = 0.87, 95% CI 0.77-0.99) were significant covariates. Insurance-related covariates were not significant in multivariate models addressing the probability of ruptured appendicitis. CONCLUSIONS: During a period of rapid managed care growth, insurance type was not associated with an increased risk of ruptured appendicitis among children in this geographic area. Age, female gender, and the number of preventive care visits are inversely related to the risk of ruptured appendix among children. The protective effect of preventive care visits suggests that a primary care relationship facilitates access to care, thus reducing delay in the management of appendicitis.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990 Nov;132(5):910–925. [PubMed]
  • Balthazar EJ, Rofsky NM, Zucker R. Appendicitis: the impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol. 1998 May;93(5):768–771. [PubMed]
  • Braveman P, Schaaf VM, Egerter S, Bennett T, Schecter W. Insurance-related differences in the risk of ruptured appendix. N Engl J Med. 1994 Aug 18;331(7):444–449. [PubMed]
  • Brender JD, Marcuse EK, Koepsell TD, Hatch EI. Childhood appendicitis: factors associated with perforation. Pediatrics. 1985 Aug;76(2):301–306. [PubMed]
  • Chande VT, Kinnane JM. Role of the primary care provider in expediting care of children with acute appendicitis. Arch Pediatr Adolesc Med. 1996 Jul;150(7):703–706. [PubMed]
  • Eldar S, Nash E, Sabo E, Matter I, Kunin J, Mogilner JG, Abrahamson J. Delay of surgery in acute appendicitis. Am J Surg. 1997 Mar;173(3):194–198. [PubMed]
  • Gadomski A, Jenkins P, Nichols M. Impact of a Medicaid primary care provider and preventive care on pediatric hospitalization. Pediatrics. 1998 Mar;101(3):E1–E1. [PubMed]
  • Golladay ES, Sarrett JR. Delayed diagnosis in pediatric appendicitis. South Med J. 1988 Jan;81(1):38–42. [PubMed]
  • Goodman DC, Fisher ES, Gittelsohn A, Chang CH, Fleming C. Why are children hospitalized? The role of non-clinical factors in pediatric hospitalizations. Pediatrics. 1994 Jun;93(6 Pt 1):896–902. [PubMed]
  • Harrison MW, Lindner DJ, Campbell JR, Campbell TJ. Acute appendicitis in children: factors affecting morbidity. Am J Surg. 1984 May;147(5):605–610. [PubMed]
  • Horwitz JR, Gursoy M, Jaksic T, Lally KP. Importance of diarrhea as a presenting symptom of appendicitis in very young children. Am J Surg. 1997 Feb;173(2):80–82. [PubMed]
  • Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH. Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg. 1997 Mar-Apr;21(3):313–317. [PubMed]
  • Linz DN, Hrabovsky EE, Franceschi D, Gauderer MW. Does the current health care environment contribute to increased morbidity and mortality of acute appendicitis in children? J Pediatr Surg. 1993 Mar;28(3):321–328. [PubMed]
  • O'Toole SJ, Karamanoukian HL, Allen JE, Caty MG, O'Toole D, Azizkhan RG, Glick PL. Insurance-related differences in the presentation of pediatric appendicitis. J Pediatr Surg. 1996 Aug;31(8):1032–1034. [PubMed]
  • Pappas G, Hadden WC, Kozak LJ, Fisher GF. Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups. Am J Public Health. 1997 May;87(5):811–816. [PMC free article] [PubMed]
  • Perrin JM. Variations in pediatric hospitalization rates: why do they occur? Pediatr Ann. 1994 Dec;23(12):676–683. [PubMed]
  • Perrin JM, Homer CJ, Berwick DM, Woolf AD, Freeman JL, Wennberg JE. Variations in rates of hospitalization of children in three urban communities. N Engl J Med. 1989 May 4;320(18):1183–1187. [PubMed]
  • Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998 Jan 15;338(3):141–146. [PubMed]
  • Rappaport WD, Peterson M, Stanton C. Factors responsible for the high perforation rate seen in early childhood appendicitis. Am Surg. 1989 Oct;55(10):602–605. [PubMed]
  • Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992 Nov 4;268(17):2388–2394. [PubMed]
  • Williams N, Bello M. Perforation rate relates to delayed presentation in childhood acute appendicitis. J R Coll Surg Edinb. 1998 Apr;43(2):101–102. [PubMed]
  • Young I, Moss KW. Acute appendicitis in children in a community hospital: a five year review. Alaska Med. 1997 Apr-Jun;39(2):34–42. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...