Asian children and black children experience higher rates of ruptured appendixes than white children, as do uninsured or Medicaid-insured children, compared to children covered by private insurance, according to a study in the October 27 issue of JAMA. The rate of "negative appendectomy" (appendix removal without appendicitis) declines at hospitals that perform more appendectomies.

According to background information in the article, the primary adverse outcome of appendicitis is appendiceal (appendix) rupture. Patients with a ruptured appendix at the time of surgical exploration have as high as a 39 percent chance of having a postsurgical complication, such as intra-abdominal abscess or wound infection, compared with an approximately 8 percent chance if the appendix is not perforated. It has been assumed that the natural history of appendix rupture is within the control of the hospital or physician and that a high rate of rupture reflects a failure of medical care.

Given the difficulty of diagnosing appendicitis in both children and adults, the traditional approach by hospitals to decrease the rupture rate has been to encourage early surgical exploration. In fact, high rates of negative exploration for appendicitis have been tolerated to lessen the likelihood of ruptured appendicitis and its complications. In essence, one complication (a negative exploration) is encouraged to decrease the incidence of another complication (appendiceal rupture). Rates for both of these in children remain high despite efforts to reduce them. Little is known about the factors that influence these rates.

Todd A. Ponsky, M.D., of Children's National Medical Center and George Washington University Medical Center, Washington, D.C., and colleagues examined the patterns of diagnosis and care of children aged 5 to 17 years with appendicitis at 36 major children's hospitals to assess the contributions of race, health insurance status, age, sex, and hospital volu
'"/>

Contact: Emily Dammeyer
202-884-4500
JAMA and Archives Journals
26-Oct-2004

Page: 1 2
Related medicine news :

1. The impact of cruciate ligament rupture on osteoarthritis of the knee
2. Mayo Clinic develops first genomic-based test to predict stroke from ruptured brain aneurysm
3. Induction at 32 weeks possible action for expectant moms with premature membrane rupture
4. Risk of uterine rupture during labor higher for women with a prior cesarean delivery
5. Study suggests some unruptured aneurysms do not need treatment
6. Protecting children from industrial chemicals in the environment
7. Study finds majority of women willing to accept cervical cancer vaccine for self and children
8. Study shows use of budesonide reduced the risk of asthma related events by 40% in children
9. Use of inhaled corticosteroid led to fewer hospitalizations for young children with asthma
10. Pushy parents can be bad for their childrens health
11. Cavity prevention tips for pre-school age children