The study aimed to compare paediatric appendicectomy practice in a specialist paediatric centre (SPC) with a district general hospital (DGH).
This was a retrospective study of children younger than 16 years treated between January 1, 2005, and September 30, 2007.
Two hundred seven patients (SPC) and 264 (DGH) had an operation for suspected appendicitis. Thirty-one percent of SPC patients were female vs 41% in the DGH (P = .03). Median age (range) was 10.3 years (1.2-15.9 years) in the SPC and 11.8 (3.3-16.0 years) in the DGH (P < or = .0001). The negative appendicectomy rate was 4% at the SPC and 20% at the DGH (P < or = .0001). Perforated appendicitis was found in 37% of children at the SPC compared with only 18% at the DGH (P < or = .0001). Median (range) length of stay was 5 days at the SPC (1-21 days) compared with 2 days at the DGH (1-21 days) (P < or = .0001).
Our findings have important implications for local practice in our 2 centres but may also have wider implications for the national organisation of the surgical care of children and for the training of general surgeons.
"Three studies on appendicitis examined whether patient outcomes differed when patients were treated in a pediatric environment compared to a nonpediatric environment   . Pediatric environments were noted to be associated with a longer length of stay in two of the studies, and were associated with higher hospital charges in one of the studies. "
[Show abstract][Hide abstract] ABSTRACT: The United States’ healthcare system is facing unprecedented pressures: the healthcare cost curve is not sustainable while the bar of standards and expectations for the quality of care continues to rise. Systems committed to the surgical treatment of children will likely require changes and reorganization. Regardless of these mounting pressures, hospitals must remain focused on providing the best possible care to each child at every encounter. Available clinical expertise and hospital resources should be optimized to match the complexity of the treated condition. Although precise criteria are lacking, there is a growing consensus that the optimal combination of clinical experience and hospital resources must be defined, and efforts toward this goal have been supported by the Regents of the American College of Surgeons, the members of the American Pediatric Surgical Association, and the Society for Pediatric Anesthesia (SPA) Board of Directors. The topic of optimizing outcomes and the discussion of the concepts involved has unfortunately become divisive. Our goal, therefore, is 1) to provide a review of the literature that can provide context for the discussion of regionalization, volume, and optimal resources and promote mutual understanding of these important terms, 2) to review the evidence that has been published to date in pediatric surgery associated with regionalization, volume, and resource, 3) to focus on a specific resource (anesthesia), and the association that this may have with outcomes, and 4) to provide a framework for future research and policy efforts.
Journal of Pediatric Surgery 05/2014; 49(5). DOI:10.1016/j.jpedsurg.2014.02.085 · 1.39 Impact Factor
"This argument is supported by the observation that the diagnostic accuracy of appendicitis has largely been unaffected by technological innovations (Hale, et al., 1997; Gnanalingham, et al., 1997). Even in recent literature the negative appendicectomy rate varies from as low as 3% (6/190) (Cleeve et al 2011) through 4% (Whisker, et al., 2009) to as high as 44 % (76/172) (Gopal and Jaffrey2011). A large part of this variation in diagnostic rate may come from differences in clinical practice but some may come from variations in histological reporting. "
"Demographic profile of the patients in this study is comparable to the other DGHs.25 Therefore the results may be generalized to children aged 3–16 years of age who present with suspected appendicitis to DGHs in the UK. "
[Show abstract][Hide abstract] ABSTRACT: Simple investigations like white cell count (WCC) and C-reactive protein (CRP) may help to improve the accuracy of diagnosis in paediatric appendicitis. We evaluated the diagnostic accuracy of WCC and CRP for the severity of acute appendicitis in children.
This study was conducted on all children who underwent open appendectomy from January 2007 to December 2008 at a District General Hospital. Data regarding demographics, WCC, CRP, histology and postoperative complications were analysed.
All children who underwent open appendectomy during the study period.
Diagnostic accuracy of WCC and CRP for simple acute appendicitis and a perforated appendix.
Out of 204 patients, 112 (54.9%) were girls. At surgery, appendix was grossly inflamed in 175 of which 32 had perforation. Histology revealed simple acute appendicitis in 135 (66.2%) and gangrenous appendicitis in 32 (15.7%). The rest were normal. The duration of symptoms, temperature, length of stay, WCC and CRP were significantly worse in the perforated group (P value <0.05). Postoperative complications included wound infection (n = 18), pelvic collection (n = 5) and intestinal obstruction (n = 6); and were more common among patients with a perforated appendix (P value <0.05). WCC had a higher diagnostic accuracy and higher sensitivity than CRP in diagnosing simple acute appendicitis. The combined sensitivity of WCC and CRP increased to 95% and 100% for the diagnosis of simple acute appendicitis and a perforated appendix, respectively.
Accuracy of WCC is higher than CRP for diagnosing simple acute appendicitis. The combined sensitivity of WCC and CRP increases for simple acute appendicitis as well as a perforated appendix.
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