Child's Appendix More Likely to Rupture in Regions Short of Surgeons

Transfer to another hospital delays treatment, researchers say

By Robert Preidt

Friday, October 31, 2014

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FRIDAY, Oct. 31, 2014 (HealthDay News) -- Children and teens with poor access to general surgeons are at increased risk of suffering a ruptured appendix, and the risk is particularly high among young children, a new study finds.

If an infected appendix isn't removed quickly enough, it can burst or rupture, leading to a serious, sometimes fatal infection, according to background information from the study.

Researchers analyzed data from nearly 7,000 children younger than 18 who were diagnosed with appendicitis at surgical centers in North Carolina between 2007 and 2009. Nearly one in four of the youngsters later suffered a ruptured appendix.

The risk of ruptured appendix was 1.7 times higher among patients who were transferred to another hospital, and 1.4 times higher among those who came from areas with a severe shortage of general surgeons, fewer than three for every 100,000 people.

Young appendicitis patients with limited access to general surgeons likely have to wait longer to be transferred and start receiving care, according to the authors of the study presented this week at an American College of Surgeons meeting in San Francisco.

Compared to children older than 12, the risk of ruptured appendix was 5.6 times higher among kids age 5 and younger, and 1.3 times higher for those ages 5 to 12.

"Transfers from other hospitals tend to be younger children. Rural surgeons may feel comfortable treating a 12- or 13-year-old, but if the child is 1 month or 5 years old, they will usually be transferred," study lead author Dr. Michael Phillips, a surgery resident at the University of North Carolina at Chapel Hill, said in a College of Surgeons news release.

Such transfers can take a couple of hours, he noted.

Another reason why younger children with appendicitis are more likely to suffer a ruptured appendix is that they can't explain what's wrong with them, which could delay diagnosis, according to the release.

"In some cases, the child will have signs of appendicitis, like eating less and a fever, but parents will think it's something else. Then they send the child to a pediatrician, wait for lab tests to come back, then have an imaging study. This process can take a while," Phillips said.

Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

SOURCE: American College of Surgeons, news release, Oct. 28, 2014

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