title: Pediatric patients transferred for operative management of appendicitis: are they at a disadvantage?
abstract: OBJECTIVE
  Many pediatric patients are initially diagnosed with appendicitis at referring hospitals and are subsequently transferred to pediatric facilities. We aimed to compare outcomes of patients transferred to a pediatric referral center to those who present primarily for operative management of appendicitis.
  
  
  METHODS
  A retrospective review of 326 patients with operative appendicitis from July 2012 to July 2013 was performed. Demographic data, clinical parameters, and outcomes were analyzed.
  
  
  RESULTS
  Transferred (n=222, 68%) and primary patients (n=104, 32%) were similar except for mean age (primary 12.4 vs. transferred 11.2 years, p<0.01). Computed tomography scans were performed in 80% of transferred compared to 40% of primary patients. Primary patients were more likely to present between the hours of 09:00 and 17:59 (52%), while transferred arrived equally across all hours. Both groups were more likely to present with acute appendicitis (primary 56% vs. transfer 61%, p=NS). There was no difference in time of diagnosis to time of appendectomy, length of hospital stay, or 30 day complications (primary 8.6% vs. transfer 5.8%, p=NS).
  
  
  CONCLUSIONS
  Patients transferred for definitive care of appendicitis are not found to have more advanced disease or have increased complications; however, they are exposed to significantly more ionizing radiation during evaluation for appendicitis.
authors: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: sfarach1@jhmi.edu.
authors: Sandra M
authors: SM
authors: Farach
authors: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: Paul.Danielson@jhmi.edu.
authors: Paul D
authors: PD
authors: Danielson
authors: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: nwalfor1@jhmi.edu.
authors: N Elizabeth
authors: NE
authors: Walford
authors: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: rharmel1@jhmi.edu.
authors: Richard P
authors: RP
authors: Harmel
authors: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: Nicole.Chandler@jhmi.edu.
authors: Nicole M
authors: NM
authors: Chandler
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000639:trends; D008297:Male; D010360:Patient Transfer; D012017:Referral and Consultation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Appendectomy; Appendicitis; Pediatric; Transfer