title: Missed opportunities in the treatment of pediatric appendicitis.
abstract: BACKGROUND
  This study sought to evaluate the outcomes of in-hospital delay and determine associated co-morbidities in the treatment of pediatric acute appendicitis.
  
  
  METHODS
  This was a retrospective analysis of the national inpatient sample from 2000 to 2008. Immediate treatment was defined as treatment in hospital day 0 or 1. Delay in treatment was defined as treatment in hospital day 2 and beyond.
  
  
  RESULTS
  During the study period, 683,016 pediatric appendicitis were identified. 17,737 (2.6%) experienced a delay in treatment. Multivariate analysis identified associated co-morbidities for delay in treatment: ALL (OR 12.84, CI 11.04-14.94), AML (OR 9.41, CI 7.58-11.68), neutropenia (OR 5.53, CI 4.60-6.65), and ovarian cyst without torsion (OR 3.17, CI 2.94-3.42). Surgical management included more than 13-fold increase in drainage procedures (5.5 vs. 0.4%), sixfold increase in cecectomy (1.2 vs. 0.2%), 14-fold increase in hemicolectomy (1.4 vs. 0.1%), 11-fold increase in small bowel laceration suture repair (1.1 vs. 0.1%), and 15-fold increase in small bowel resection (1.5 vs. 0.1%).
  
  
  CONCLUSIONS
  In-hospital delay beyond 2 days is associated with significant negative outcomes with regard to complications, economic burden, and subsequent surgical management. Using the co-morbidity index, high-risk co-morbidities with associated delay in treatment were identified.
authors.affiliation: Baystate Children's Hospital, Tufts University School of Medicine, Springfield, MA 01199, USA. Justin.Lee@tufts.edu
authors.forename: Justin
authors.initials: J
authors.lastname: Lee
authors.forename: David B
authors.initials: DB
authors.lastname: Tashjian
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Moriarty
mesh_terms: D000208:Acute Disease; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D015470:Leukemia, Myeloid, Acute / Q000150:complications; D008297:Male; D009503:Neutropenia / Q000150:complications; D016017:Odds Ratio; D010048:Ovarian Cysts / Q000150:complications; D011183:Postoperative Complications; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome