Nationwide study of appendicitis in children

Abstract

Background: Paediatric surgical care is increasingly being centralized away from low-volume centres, and prehospital delay is considered a risk factor for more complicated appendicitis. The aim of this study was to determine the incidence of paediatric appendicitis in Sweden, and to assess whether distance to the hospital was a risk factor for complicated disease. Methods: A nationwide cohort study of all paediatric appendicitis cases in Sweden, 2001-2014, was undertaken, including incidence of disease in different population strata, with trends over time. The risk of complicated disease was determined by regression methods, with travel time as the primary exposure and individual-level socioeconomic determinants as independent variables. Results: Some 38 939 children with appendicitis were identified. Of these, 16⋅8 per cent had complicated disease, and the estimated risk of paediatric appendicitis by age 18 years was 2⋅5 per cent. Travel time to the treating hospital was not associated with complicated disease (adjusted odds ratio (OR) 1⋅00 (95 per cent c.i. 0⋅96 to 1⋅05) per 30-min increase; P = 0⋅934). Level of education (P = 0⋅177) and family income (P = 0⋅120) were not independently associated with increased risk of complicated disease. Parental unemployment (adjusted OR 1⋅17, 95 per cent c.i. 1⋅05 to 1⋅32; P = 0⋅006) and having parents born outside Sweden (1 parent born in Sweden: adjusted OR 1⋅12, 1⋅01 to 1⋅25; both parents born outside Sweden: adjusted OR 1⋅32, 1⋅18 to 1⋅47; P < 0⋅001) were associated with an increased risk of complicated appendicitis. Conclusion: Every sixth child diagnosed with appendicitis in Sweden has a more complicated course of disease. Geographical distance to the surgical facility was not a risk factor for complicated appendicitis.

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

“…Less than 19% of children have a complicated acute appendicitis; hence, the majority of children with uncomplicated AA may be considered for either a non-operative or an operative management [ 112 ].…”

How boys and testicles wander to surgery: a nationwide cohort study of surgical delay in Sweden

“…Interestingly, in this context, increasing travel distance was not associated with adverse outcome in paediatric appendicitis, which may reflect the generally shorter distances to emergency hospitals. 38 A few studies of cryptorchidism, in various healthcare systems and populations, have reported treatment delays for children with worse insurance status or lower average income and education in neighbourhood area of residence. 2 21 This effect seems context specific, as indicated by a Canadian study showing that average deprivation status and income level in area of residence did not associate with treatment delays in paediatric surgery in general.…”

Ultrastructural Changes of Blood Cells in Children with Generalized Purulent Peritonitis: A Cross-Sectional and Prospective Study

“…The risk for developing AA during one’s lifetime is 8.6% for men and 6.7% for women, with the illness most often occurring between the ages of 10 and 30 [ 3 ]. In a study by Omling et al [ 4 ] conducted on a group of 38,939 children, the estimated risk of the appearance of AA in patients under age 18 was 2.5%. In epidemiological studies, geographical variations have been noted in the incidence of the illness over the course of a lifetime, with a frequency of 16% in South Korea, 9% in the USA, and 1.8% in Africa [ 5 , 6 ].…”