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Abstract：
To determine the association of emergency department (ED) volume of children and delayed diagnosis of appendicitis.
Delayed diagnosis of appendicitis is common in children. The association between ED volume and delayed diagnosis is uncertain, but diagnosis-specific experience might improve diagnostic timeliness.
Using Healthcare Cost and Utilization Project 8-state data from 2014 to 2019, we studied all children with appendicitis <18 years old in all EDs. The main outcome was probable delayed diagnosis: >75% likelihood that a delay occurred based on a previously validated measure. Hierarchical models tested associations between ED volumes and delay, adjusting for age, sex, and chronic conditions. We compared complication rates by delayed diagnosis occurrence.
Among 93,136 children with appendicitis, 3,293 (3.5%) had delayed diagnosis. Each 2-fold increase in ED volume was associated with a 6.9% (95% CI: 2.2, 11.3) decreased odds of delayed diagnosis. Each 2-fold increase in appendicitis volume was associated with a 24.1% (95% CI: 21.0, 27.0) decreased odds of delay. Those with delayed diagnosis were more likely to receive intensive care [odds ratio (OR): 1.81, 95% CI: 1.48, 2.21], have perforated appendicitis (OR: 2.81, 95% CI: 2.62, 3.02), undergo abdominal abscess drainage (OR: 2.49, 95% CI: 2.16, 2.88), have multiple abdominal surgeries (OR: 2.56, 95% CI: 2.13, 3.07), or develop sepsis (OR: 2.02, 95% CI: 1.61, 2.54).
Higher ED volumes were associated with a lower risk of delayed diagnosis of pediatric appendicitis. Delay was associated with complications.
Delayed diagnosis of appendicitis is common in children. The association between ED volume and delayed diagnosis is uncertain, but diagnosis-specific experience might improve diagnostic timeliness.
Using Healthcare Cost and Utilization Project 8-state data from 2014 to 2019, we studied all children with appendicitis <18 years old in all EDs. The main outcome was probable delayed diagnosis: >75% likelihood that a delay occurred based on a previously validated measure. Hierarchical models tested associations between ED volumes and delay, adjusting for age, sex, and chronic conditions. We compared complication rates by delayed diagnosis occurrence.
Among 93,136 children with appendicitis, 3,293 (3.5%) had delayed diagnosis. Each 2-fold increase in ED volume was associated with a 6.9% (95% CI: 2.2, 11.3) decreased odds of delayed diagnosis. Each 2-fold increase in appendicitis volume was associated with a 24.1% (95% CI: 21.0, 27.0) decreased odds of delay. Those with delayed diagnosis were more likely to receive intensive care [odds ratio (OR): 1.81, 95% CI: 1.48, 2.21], have perforated appendicitis (OR: 2.81, 95% CI: 2.62, 3.02), undergo abdominal abscess drainage (OR: 2.49, 95% CI: 2.16, 2.88), have multiple abdominal surgeries (OR: 2.56, 95% CI: 2.13, 3.07), or develop sepsis (OR: 2.02, 95% CI: 1.61, 2.54).
Higher ED volumes were associated with a lower risk of delayed diagnosis of pediatric appendicitis. Delay was associated with complications.
摘要：
目的：确定急诊（ED）患儿数量与阑尾炎延迟诊断的关系。
背景：阑尾炎的延迟诊断在儿童中很常见。ED体积和延迟诊断之间的关联是不确定的，但特定诊断经验可能会提高诊断及时性.
方法：使用2014-2019年的医疗保健成本和利用项目8州数据，我们研究了所有ED中所有<18岁的阑尾炎儿童。主要结果是可能的延迟诊断：根据先前验证的措施，延迟发生的可能性>75％。分层模型测试了ED卷和延迟之间的关联，调整年龄，性别,和慢性病。我们比较了延迟诊断的并发症发生率。
结果：在93,136名阑尾炎儿童中，3,293（3.5％）延迟诊断。ED体积每增加两倍，延迟诊断的几率降低6.9％（95％置信区间[CI]2.2，11.3）。阑尾炎体积每增加两倍，延迟几率降低24.1%（95%CI21.0，27.0）。延迟诊断的患者更有可能接受重症监护（比值比[OR]1.81，95％CI1.48，2.21），有穿孔性阑尾炎(OR2.81，95%CI2.62，3.02)，接受腹腔脓肿引流（OR2.49，95%CI2.16，2.88），有多次腹部手术(OR2.56，95%CI2.13，3.07)，或发展为脓毒症（OR2.02，95%CI1.61，2.54）。
结论：较高的ED体积与儿童阑尾炎延迟诊断的风险较低相关。延迟与并发症有关。
背景：阑尾炎的延迟诊断在儿童中很常见。ED体积和延迟诊断之间的关联是不确定的，但特定诊断经验可能会提高诊断及时性.
方法：使用2014-2019年的医疗保健成本和利用项目8州数据，我们研究了所有ED中所有<18岁的阑尾炎儿童。主要结果是可能的延迟诊断：根据先前验证的措施，延迟发生的可能性>75％。分层模型测试了ED卷和延迟之间的关联，调整年龄，性别,和慢性病。我们比较了延迟诊断的并发症发生率。
结果：在93,136名阑尾炎儿童中，3,293（3.5％）延迟诊断。ED体积每增加两倍，延迟诊断的几率降低6.9％（95％置信区间[CI]2.2，11.3）。阑尾炎体积每增加两倍，延迟几率降低24.1%（95%CI21.0，27.0）。延迟诊断的患者更有可能接受重症监护（比值比[OR]1.81，95％CI1.48，2.21），有穿孔性阑尾炎(OR2.81，95%CI2.62，3.02)，接受腹腔脓肿引流（OR2.49，95%CI2.16，2.88），有多次腹部手术(OR2.56，95%CI2.13，3.07)，或发展为脓毒症（OR2.02，95%CI1.61，2.54）。
结论：较高的ED体积与儿童阑尾炎延迟诊断的风险较低相关。延迟与并发症有关。
