Newman Kurt, Ponsky Todd, Kittle Kory, Dyk Lorna, Throop Cheri, Gieseker Karen, Sills Marion, Gilbert James
Department of Surgery, Children's National Medical Center and George Washington University School of Medicine, Washington, DC, USA.
J Pediatr Surg. 2003 Mar;38(3):372-9; discussion 372-9. doi: 10.1053/jpsu.2003.50111.
BACKGROUND/PURPOSE: To improve clinical results and resource utilization in the care of appendicitis in children, the authors examined the current practice and outcomes of 30 pediatric hospitals.
The Pediatric Health Information System (PHIS) database consists of comparative data from 30 free-standing Children's hospitals. The study population of 3,393 children was derived from the database by selecting the "Diagnosis Related Group Code" for appendicitis (APRDRGv12 164), ages 0 to 17 years, using discharges between October 1, 1999 and September 30, 2000. Data are expressed as the range and median for individual hospital outcomes.
The nonpositive appendectomy rate ranged from 0 to 17% at the 30 hospitals (median, 2.6%). Ruptured appendicitis varied from 20% to 76% (median, 36.5%). The median length of stay (LOS) for nonruptured appendicitis was 2 days (range, 1.4 to 3.1 days), ruptured appendicitis varied from 4.4 to 11 days (median, 6 days). The median readmission rate within 14 days was 4.3% (0 to 10%). Laparoscopic appendectomy varied from 0 to 95% in the 30 hospitals (mean, 31%) The LOS did not vary significantly in laparoscopic versus open for nonruptured (2.3 v 2.0 days) or ruptured appendicitis (5.5 v 6.2 days). Days on antibiotics for ruptured appendicitis ranged from 4.6 to 7.9 days (median, 5.9 days) Children receiving any study varied from 18% to 89% (median, 69%). Ultrasound scan and computed tomography (CT) were comparable in both nonruptured (13% ultrasound scan v 14%) and ruptured appendicitis (14% ultrasound scan v 21% CT).
Significant variability in practice patterns and resource utilization exists in the management of acute appendicitis in pediatric hospitals. Clinical outcomes could be improved by collaborative initiatives to adopt evidence-based best practices.
背景/目的：为了改善儿童阑尾炎治疗的临床效果和资源利用情况，作者研究了30家儿科医院的当前治疗方法及治疗结果。
儿科健康信息系统（PHIS）数据库包含来自30家独立儿童医院的对比数据。研究人群为3393名儿童，从数据库中选取1999年10月1日至2000年9月30日期间年龄在0至17岁、诊断相关组代码为阑尾炎（APRDRGv12 164）的病例。数据以各医院治疗结果的范围和中位数表示。
30家医院的阴性阑尾切除术率在0至17%之间（中位数为2.6%）。阑尾破裂率在20%至76%之间（中位数为36.5%）。未破裂阑尾炎的中位住院时间为2天（范围为1.4至3.1天），阑尾破裂的住院时间在4.4至11天之间（中位数为6天）。14天内的中位再入院率为4.3%（0至10%）。30家医院的腹腔镜阑尾切除术率在0至95%之间（平均为31%）。对于未破裂（2.3天对2.0天）或破裂阑尾炎（5.5天对6.2天），腹腔镜手术与开放手术的住院时间无显著差异。阑尾破裂患儿使用抗生素的天数在4.6至7.9天之间（中位数为5.9天）。接受任何研究治疗的儿童比例在18%至89%之间（中位数为69%）。超声扫描和计算机断层扫描（CT）在未破裂阑尾炎（超声扫描13%对CT 14%）和破裂阑尾炎（超声扫描14%对CT 21%）中的应用相当。
儿科医院在急性阑尾炎的治疗模式和资源利用方面存在显著差异。通过采取循证最佳实践的合作倡议，临床结果可能会得到改善。
