July 1996

Role of the Primary Care Provider in Expediting Care of Children With Acute Appendicitis

Author Affiliations

From the Department of Pediatrics, University of Pittsburgh (Pa) School of Medicine and the Children's Hospital of Pittsburgh.

Arch Pediatr Adolesc Med. 1996;150(7):703-706. doi:10.1001/archpedi.1996.02170320049008

Objective:  To assess the role of the primary care provider (PCP) in the diagnosis and treatment of acute appendicitis in children by determining whether there were differences in the treatment and outcome of children whose parents contacted the PCP before taking the child to the hospital compared with those who did not.

Design:  Retrospective review of medical records of pediatric patients discharged from the hospital with the diagnosis of acute appendicitis.

Setting:  An urban children's hospital.

Methods:  The medical records of children treated for acute appendicitis from July 1,1990, through June 30, 1994, were identified through review of hospital discharge data and divided into 2 groups based on whether the children's parents had contacted the PCP before their arrival at the hospital. Contact with the PCP was determined by record review or telephone interview with the parent. The 2 groups were then studied for differences in treatment and outcome. Statistical analysis was by the χ2 test and the Student t test, as appropriate, with the level of significance determined at P<.05.

Results:  During the 4-year period, 343 children underwent appendectomy. Medical records were available for review for 321 children (94%). After review, records of 38 children were excluded because the primary problem was not acute appendicitis. Of the 283 children whose records were included in the study, the parents of 160 had contacted the PCP before arrival at the hospital (group 1, those who called) and the parents of 99 had not called (group 2, those who did not call). It could not be determined whether a call had been made for 24 children. The mean age of the children in group 1 was 124 months and in group 2 was 126 months (P=.74). Of group 1,24% arrived at the hospital on a Saturday or Sunday, compared with 40% of group 2 (P=.007). Children in group 1 who arrived at the hospital during the weekend were operated on a mean (SD) of 4.7 hours (3.7 hours) after arrival at the hospital, compared with 10.6 hours (17.1 hours) for children in group 2 (P=.04). The mean (SD) interval between arrival at the hospital and operation on weekdays (Monday through Friday) was similar in both groups: 12 hours (20.6 hours) in group 1 and 13.7 hours (25.6 hours) in group 2 (P=.63). Appendiceal perforation was less likely in children in group 1 (62/160 [39%]) than in those in group 2 (53/99 [54%]; P=.03). Parents of 50 (89%) of 56 children who belonged to a health maintenance organization called the PCP compared with 96 (62%) of the 156 with fee-for-service insurance and 10 (26%) of the 38 with Medicaid (P<.001). No difference was noted in the interval between arrival at the hospital and operation or incidence of appendiceal perforation according to type of insurance.

Conclusions:  Children with appendicitis whose parents contacted the PCP before arrival at the hospital were less likely to have appendiceal perforation than those whose parents did not call the PCP, irrespective of insurance status. Children whose parents called the PCP before arrival at the hospital during the weekend were operated on more promptly than were children whose parents did not call the PCP. Contact with the PCP was associated with more expeditious care of children with acute appendicitis.Arch Pediatr Adolesc Med. 1996;150:703-706