Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California.
J Surg Res. 2024 Aug;300:54-62. doi: 10.1016/j.jss.2024.04.065. Epub 2024 May 24.
Pediatric surgical care is becoming increasingly regionalized, often resulting in limited access. Interfacility transfers pose a significant financial and emotional burden to when they are potentially avoidable. Of transferred patients, we sought to identify clinical factors associated with avoidable transfers in pediatric patients with suspected appendicitis.
We performed a single-center retrospective study at an academic tertiary referral children's hospital in an urban setting. We included children who underwent interfacility transfer to our center with a transfer diagnosis of appendicitis from July 1, 2021 to June 30, 2023. Encounters were designated as either an appropriate transfer (underwent appendectomy) or an avoidable transfer (did not undergo appendectomy). Encounters treated nonoperatively for complicated appendicitis were excluded. Bivariate analysis was performed using Mann-Whitney test and chi-square tests.
A total of 444 patients were included: 71.2% were classified as appropriate transfers and 28.8% as avoidable transfers. Patients with avoidable transfer were younger compared to those in the appropriate transfer cohort (median age 9 y, interquartile range: 7-13 versus 11 y, interquartile range: 8-14; P < 0.001). Avoidable transfers less frequently presented with the typical symptoms of fever, migratory abdominal pain, anorexia, and nausea/emesis (P = 0.005). Avoidable transfers also reported shorter symptom duration (P = 0.040) with lower median white blood cell count (P < 0.001), neutrophil percentage (P < 0.001), and C-reactive protein levels (P < 0.003). Avoidable transfers more frequently underwent repeat imaging upon arrival (42.9% versus 12.7%, P < 0.001).
These findings highlight the importance of clinical history in children with suspected appendicitis. Younger patients without typical symptoms of appendicitis, those with a shorter duration of symptoms, and lower serum inflammatory markers may benefit from close observation without transfer.
小儿外科护理日益区域化，通常导致获得途径有限。当这些转移可能是可以避免时，医院间的转移会给患者带来重大的经济和情感负担。在我们的研究中，我们旨在确定与疑似阑尾炎的儿科患者的可避免转移相关的临床因素。
我们在一个城市环境中的学术三级转诊儿童医院进行了一项单中心回顾性研究。我们纳入了从 2021 年 7 月 1 日至 2023 年 6 月 30 日期间因阑尾炎转移至我院的患儿。将这些转移的患儿分为适当转移（接受阑尾切除术）和可避免转移（未接受阑尾切除术）。排除接受复杂阑尾炎非手术治疗的患儿。使用 Mann-Whitney 检验和卡方检验进行了二变量分析。
共有 444 名患儿被纳入研究：71.2%被归类为适当转移，28.8%为可避免转移。与适当转移组相比，可避免转移组的患儿年龄更小（中位数 9 岁，四分位距：7-13 岁与 11 岁，四分位距：8-14 岁；P<0.001）。可避免转移的患儿更常出现发热、腹痛转移、厌食和恶心/呕吐等非典型症状（P=0.005）。可避免转移的患儿还报告了较短的症状持续时间（P=0.040），白细胞计数（P<0.001）、中性粒细胞百分比（P<0.001）和 C 反应蛋白水平（P<0.003）更低。可避免转移的患儿在到达时更常进行重复影像学检查（42.9%与 12.7%，P<0.001）。
这些发现强调了在疑似阑尾炎的患儿中临床病史的重要性。无典型阑尾炎症状、症状持续时间较短、血清炎症标志物水平较低的年轻患者可能受益于密切观察而无需转移。
