Health outcomes in US children with abdominal pain at major emergency departments associated with race and socioeconomic status.
OBJECTIVE
Over 9.6 million ED visits occur annually for abdominal pain in the US, but little is known about the medical outcomes of these patients based on demographics. We aimed to identify disparities in outcomes among children presenting to the ED with abdominal pain linked to race and SES.


METHODS
Data from 4.2 million pediatric encounters of abdominal pain were analyzed from 43 tertiary US children's hospitals, including 2.0 million encounters in the emergency department during 2004-2011. Abdominal pain was categorized as functional or organic abdominal pain. Appendicitis (with and without perforation) was used as a surrogate for abdominal pain requiring emergent care. Multivariate analysis estimated likelihood of hospitalizations, radiologic imaging, ICU admissions, appendicitis, appendicitis with perforation, and time to surgery and hospital discharge.


RESULTS
Black and low income children had increased odds of perforated appendicitis (aOR, 1.42, 95% CI, 1.32- 1.53; aOR, 1.20, 95% CI 1.14 - 1.25). Blacks had increased odds of an ICU admission (aOR, 1.92, 95% CI 1.53 - 2.42) and longer lengths of stay (aHR, 0.91, 95% CI 0.86 - 0.96) than Whites. Minorities and low income also had lower rates of imaging for their appendicitis, including CT scans. The combined effect of race and income on perforated appendicitis, hospitalization, and time to surgery was greater than either separately.


CONCLUSIONS
Based on race and SES, disparity of health outcomes exists in the acute ED setting among children presenting with abdominal pain, with differences in appendicitis with perforation, length of stay, and time until surgery.
School of Medicine, Stanford University, Stanford, CA, United States of America.
Louise
L
Wang
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States of America.
Corinna
C
Haberland
Children's Hospital Association, Overland Park, KS, United States of America.
Cary
C
Thurm
Center for Health Policy/ Primary Care Outcomes Research, Stanford University, Stanford, CA, United States of America; Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America; Department of Economics, Stanford University, Stanford, CA, United States of America.
Jay
J
Bhattacharya
Center for Health Policy/ Primary Care Outcomes Research, Stanford University, Stanford, CA, United States of America; Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America.
K T
KT
Park
D015746:Abdominal Pain / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000208:ethnology / Q000601:surgery*; D000293:Adolescent; D001741:Black or African American; D001064:Appendicitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000208:ethnology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000941:ethics* / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000941:ethics* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000941:ethics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D012923:Social Class; D061665:Time-to-Treatment / Q000941:ethics* / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States; D044465:White People