Health Care Utilization and Pediatric Appendicitis: Insights From an Integrated Health System.

BACKGROUND: Disparities in pediatric appendicitis severity are associated with health care utilization. Identifying factors that influence the time to diagnosis may reveal opportunities to reduce the disparities. Health care utilization patterns and appendicitis outcomes were compared by neighborhood deprivation index within an integrated health care system to identify areas for intervention to improve pediatric appendicitis outcomes.

METHODS: The authors conducted a multicenter retrospective cohort study of pediatric patients undergoing appendectomy between January 1, 2022, and June 30, 2023. Neighborhood deprivation index was categorized as less deprived (quintiles 1-3) or more deprived (quintiles 4-5). Primary outcomes were complicated vs simple appendicitis, hospital length of stay, and 30-day readmission. Secondary analyses examined prehospital health care utilization. Multivariable models assessed associations between neighborhood deprivation index, care patterns, and appendicitis severity.

RESULTS: Of 1138 patients, 20% presented with complicated appendicitis. Patients from more-deprived neighborhoods (36.9%) had higher odds of complicated appendicitis (adjusted odds ratio [aOR], 1.6; 95% confidence interval [CI], 1.2-2.2). Prehospital health care utilization was low (12.6%) and more likely among patients from more-deprived than less-deprived neighborhoods (15% vs 11%; P < .05). Longer time to hospitalization (aOR, 1.27/d; 95% CI, 1.03-1.59) and type of prehospital encounter (emergency department [aOR, 2.96; 95% CI, 1.04-9.63] or virtual care [aOR, 4.04; 95% CI, 1.33-13.82] compared with office visits) were associated with complicated appendicitis.

CONCLUSION: Modifiable health care delivery factors between the initial health care encounter and hospitalization represent potential areas for improving timely diagnosis and reducing disparities in pediatric appendicitis.