Role of the primary care provider in expediting care of children with acute appendicitis
V. T. Chande and J. M. Kinnane
Department of Pediatrics, University of Pittsburgh (Pa) School of Medicine, USA.
OBJECTIVE: To assess the role of the primary care provider (PCP) in the
diagnosis and treatment of acute appendicitis in children by determining
whether there were differences in the treatment and outcome of children
whose parents contacted the PCP before taking the child to the hospital
compared with those who did not. DESIGN: Retrospective review of medical
records of pediatric patients discharged from the hospital with the
diagnosis of acute appendicitis. SETTING: An urban children's hospital.
METHODS: The medical records of children treated for acute appendicitis
from July 1, 1990, through June 30, 1994, were identified through review of
hospital discharge data and divided into 2 groups based on whether the
children's parents had contacted the PCP before their arrival at the
hospital. Contact with the PCP was determined by record review or telephone
interview with the parent. The 2 groups were then studied for differences
in treatment and outcome. Statistical analysis was by the X2 test and the
Student t test, as appropriate, with the level of significance determined
at P < .05. RESULTS: During the 4-year period, 343 children underwent
appendectomy. Medical records were available for review for 321 children
(94%). After review, records of 38 children were excluded because the
primary problem was not acute appendicitis. Of the 283 children whose
records were included in the study, the parents of 160 had contacted the
PCP before arrival at the hospital (group 1, those who called) and the
parents of 99 had not called (group 2, those who did not call). It could
not be determined whether a call had been made for 24 children. The mean
age of the children in group 1 was 124 months and in group 2 was 126 months
(P = .74). Of group 1, 24% arrived at the hospital on a Saturday or Sunday,
compared with 40% of group 2 (P = .007). Children in group 1 who arrived at
the hospital during the weekend were operated on a mean (SD) of 4.7 hours
(3.7 hours) after arrival at the hospital, compared with 10.6 hours (17.1
hours) for children in group 2 (P = .04). The mean (SD) interval between
arrival at the hospital and operation on weekdays (Monday through Friday)
was similar in both groups: 12 hours (20.6 hours) in group 1 and 13.7 hours
(25.6 hours) in group 2 (P = .63). Appendiceal perforation was less likely
in children in group 1 (62/160 [39%]) than in those in group 2 (53/99
[54%]; P = .03). Parents of 50 (89%) of 56 children who belonged to a
health maintenance organization called the PCP compared with 96 (62%) of
the 156 with fee-for-service insurance and 10 (26%) of the 38 with Medicaid
(P < .001). No difference was noted in the interval between arrival at
the hospital and operation or incidence of appendiceal perforation
according to type of insurance. CONCLUSIONS: Children with appendicitis
whose parents contacted the PCP before arrival at the hospital were less
likely to have appendiceal perforation than those whose parents did not
call the PCP, irrespective of insurance status. Children whose parents
called the PCP before arrival at the hospital during the weekend were
operated on more promptly than were children whose parents did not call the
PCP. Contact with the PCP was associated with more expeditious care of
children with acute appendicitis.
