title: Regional variation in rates of pediatric perforated appendicitis.
abstract: BACKGROUND
  While trends in perforated appendicitis (PA) rates have been studied, regional variability in pediatric admissions for PA remains unknown.
  
  
  METHODS
  A retrospective, cross-sectional analysis of the 2006-2012 Kids' Inpatient Database was conducted to examine variation in PA admission rates by region of the United States and insurance status. PA rates were calculated and reported as per 1000 admissions in accordance with national quality measure specifications.
  
  
  RESULTS
  National PA rates per 1000 admissions for 2006, 2009, and 2012 were 313.9, 279.2, and 309.1, respectively. Similarly, all regions demonstrated a statistically significant decrease in PA rates between 2006 and 2009 (p<0.001), where the increase in rates between 2009 and 2012 was only statistically significant in the Midwest [Odds Ratio (OR) 1.07; 95% Confidence Interval (95%CI) 1.03-1.12] and West (OR 1.10; 95% CI 1.07-1.14). The Northeast consistently experienced the lowest PA rates. The odds of PA were highest among uninsured patients (OR 1.35; 95% CI 1.31-1.29). The South had the highest proportion of uninsured children, and these patients had the highest odds of perforation (OR 1.57; 95% CI 1.21-2.02).
  
  
  CONCLUSIONS
  For children with appendicitis, geographic region and insurance status appear to be associated with perforation upon presentation. Understanding regional variation in pediatric PA rates may inform health policymakers in the constantly evolving insurance coverage landscape.
  Level III Treatment Study - Retrospective comparative study of appendicitis presentation in children by region of the country.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Sarda
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Short
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hockenberry
authors.affiliation: Deparment of Economics, Emory University, Atlanta, GA, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: McCarthy
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. Electronic address: mehulvraval@emory.edu.
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
mesh_terms: D001062:Appendectomy / Q000191:economics / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000191:economics / Q000453:epidemiology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008913:Minority Groups; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
keywords: Health outcomes; Kids' Inpatient Database (KID); Pediatric quality indicators; Pediatric surgery; Perforated appendicitis