Potential barriers associated with increased prevalence of perforated appendicitis in Colorado's pediatric Medicaid population.
OBJECTIVE
We sought to identify barriers and delays in care associated with the increased prevalence of perforated appendicitis among Colorado's pediatric Medicaid population.


METHODS
We conducted a retrospective cohort study of all cases of pediatric appendicitis, which had Colorado Medicaid from 2007 to 2008 using descriptive statistics, bivariate analysis, and multivariable logistic regression.


RESULTS
Of the 479 appendicitis cases, 42.6% were perforated. In both the bivariate and multivariate analysis, perforated cases did not significantly differ from nonperforated cases with respect to sex, rurality of residence, or race with the exception of black race in the multivariate model. Perforated cases were more likely to be younger, have been enrolled in Medicaid for less than 6 months, have seen a provider within 5 days of their diagnosis, and have been transferred to another hospital for treatment.


CONCLUSIONS
The high prevalence of perforated appendicitis in Colorado children with Medicaid coverage is not associated with race or physical proximity to care but may be associated with the duration of Medicaid coverage, which highlights the importance of establishing medical homes to direct patients on where and how to seek care.
Department of Emergency Medicine, Denver Health Medical Center, MC #0108, Denver, CO 80206, USA. satrent@gmail.com
Stacy A
SA
Trent
Morgan A
MA
Valley
Katie
K
Brookler
Jason S
JS
Haukoos
Judy T
JT
Zerzan
D000293:Adolescent; D001064:Appendicitis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D008484:Medicaid; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D010360:Patient Transfer; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012423:Rural Health; D013997:Time Factors; D014481:United States