Katherine J. Baxter|Hannah T. M. H. Nguyen|Mark L. Wulkan|Mehul V. Raval
Association of Health Care Utilization With Rates of Perforated Appendicitis in Children 18 Years or Younger
Emory University|Children's Healthcare of Atlanta|Emory University|Children's Healthcare of Atlanta|Emory University|Children's Healthcare of Atlanta|Emory University|Children's Healthcare of Atlanta
pediatric perforated appendix rate quality metric measured agency healthcare research quality ahrq reflects access care association health care utilization prior presentation appendicitis unknownto determine whether increased health care utilization prior presentation appendicitis associated lower perforated appendicitis rates childrenretrospective cohort study privately insured children drawn large employer insurance company administrative data found truven marketscan national insurance claims database cases appendicitis identified among 38 348 children 18 years younger january 1 2010 december 31 2013 corresponding primary health care encounters january 1 2009 december 31 2012 19 109 eligible children identified using international classification diseases ninth revision icd9 diagnosis codes appendicitis excluding patients continuous insurance coverage study period statistical analysis performed september 1 2016 october 15 2017health care utilization determined number outpatient clinic encounters patient 1 12 months presentation appendicitisperforated appendicitis defined according ahrq using icd9 codes perforation hospital length stay 3 days logistic regression models used perforated appendicitis adjustment age sex income gastrointestinal comorbidities geographic region insurance typewe identified 38 348 children 18 years younger icd9 diagnosis codes appendicitis 19 109 children remained analysis applying exclusion criteria 11 422 boys 598 mean sd age 124 39 years 19 109 children identified underwent appendectomy 5509 288 presented perforated appendicitis children perforation lower outpatient health care utilization year presentation compared diagnosed acute appendicitis 4554 5509 children 827 vs 11 937 13 600 878 p 001 adjusted model outpatient health care utilization presentation associated lower odds perforated appendicitis odds ratio 063 95 ci 058069 p 001 association increased visit frequency year presentation 086 95 ci 077095 12 visits p 003 061 95 ci 055067 36 visits p 001 043 95 ci 038048 7 visits 518 years p 001 covariates associated perforation included younger age geographic region family income higher outofpocket insurance plansamong insured children 18 years younger increased health care utilization associated lower rates perforated appendicitis primary health care relationships may facilitate timely presentation serve marker healthrelated selfefficacy thereby contributing outcomes acute surgical conditions