Abstract
Introduction
The US–Mexico border is medically underserved. Recent political changes may render this population even more vulnerable. We hypothesized that children on the border present with high rates of perforated appendicitis due to socioeconomic barriers.
Methods
A prospective survey was administered to children presenting with appendicitis in El Paso, Texas. Primary outcomes were rate of perforation and reason for diagnostic delay. We evaluated the association between demographics, potential barriers to care, risk of perforation and risk of misdiagnosis using logistic regression. p < 0.05 was considered significant.
Results
98 patients participated from October 2016 to February 2017. 96 patients (98%) were Hispanic and 81 (82%) had Medicaid or were uninsured. 11 patients (11%) resided in Mexico or Guatemala. Patients were less likely to receive a CT and more likely to receive an ultrasound if they presented to a freestanding children’s hospital (p = 0.01). 37 patients (38%) presented with perforation, of which 19 (52%) were the result of practitioner misdiagnosis. Patients who presented to a freestanding children’s hospital were less likely to be misdiagnosed than patients presenting to other facilities (p = 0.05). Children who underwent surgery in a freestanding children’s hospital had the shortest length of stay after adjusting for perforation status and potential confounders (p < 0.01).
Conclusion
Children with low socioeconomic status did not have difficulty accessing care on the USA–Mexico border, but they were commonly misdiagnosed. Children were less likely to receive a CT, more likely to be correctly diagnosed and length of stay was shorter when patients presented to a freestanding children’s hospital.
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Acknowledgements
This work was supported in part by the Meier–Mounsey Endowment in Global Pediatric Surgery at Paul L Foster School of Medicine, Texas Tech UHSC, El Paso. The Duke Biostatistics Core’s support of this project was made possible, in part, by Grant number UL1TR001117 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.
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Research involving human participants or animals
This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board at Texas Tech UHSC, El Paso.
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Informed consent was obtained from all individual participants included in the study.
Appendix: Survey questions
Appendix: Survey questions
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Anderson, C., Peskoe, S., Parmer, M. et al. Children with appendicitis on the US–Mexico border have socioeconomic challenges and are best served by a freestanding children’s hospital. Pediatr Surg Int 34, 1269–1280 (2018). https://doi.org/10.1007/s00383-018-4353-y
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DOI: https://doi.org/10.1007/s00383-018-4353-y