title: Appendicitis in northern aboriginal children: does delay in definitive treatment affect outcome?
abstract: BACKGROUND
  The treatment of northern aboriginal children (NAC) is often complicated by distance from a treating facility. We sought to compare outcomes of NAC requiring transfer with appendicitis to those who presented locally. We hypothesized that NAC with appendicitis experienced higher rates of perforation and increased length of stay (LOS).
  
  
  METHODS
  A retrospective chart review of 210 appendectomies was performed. Charts were reviewed for age, sex, weight, days of symptoms before presentation, time of transfer, leukocyte count (white blood cell count), usage of antibiotics prior to transfer, time to operation, type of procedure and findings, pathology, postoperative outcomes, and LOS.
  
  
  RESULTS
  Sixty-eight children were NAC, whereas 142 were local. The average transfer times for NAC was 10 hours (range, 4-20 hours). The two groups had similar ages (11.1 vs 10.7 years), time to presentation (1.64 vs 1.85 days), and LOS (2.91 vs 2.90 days). Significantly higher perforation rates (44 vs 28%; P = .02), higher white blood cell count (17.9 vs 16.0; P = .02), and longer times to operation after arrival (10.3 vs 7.0 hours; P = .0002) were noted in NAC. Postoperative complications were similar between groups. Forty-seven (69%) NAC received antibiotics prior to transfer, which did not affect rate of rupture.
  
  
  CONCLUSIONS
  NAC with appendicitis experience longer transfer times and higher perforation rates than local children without a difference in length of stay or complications. Pretransfer antibiotics do not reduce perforation rates but may impact complications. We endorse their use if a delay in transfer is anticipated.
authors.affiliation: Division of Pediatric General Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada H3H1P3.
authors.forename: Alana
authors.initials: A
authors.lastname: Beres
authors.forename: Saleh
authors.initials: S
authors.lastname: Al-Abbad
authors.forename: Pramod S
authors.initials: PS
authors.lastname: Puligandla
mesh_terms: D044467:American Indian or Alaska Native; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D006801:Humans; D010360:Patient Transfer; D011183:Postoperative Complications; D011792:Quebec; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome