This finding "is troubling," writes lead researcher Todd A. Ponsky, MD, a professor of surgery at Children's National Medical Center and George Washington University Medical Center in Washington, D.C.
His report appears in the latest issue of The Journal of the American Medical Association.
People with a ruptured appendix run a significantly higher risk of complications following surgery compared with people who have surgery to remove the appendix before it ruptures. A ruptured appendix can spread infection throughout the abdomen.
It has been assumed that ruptured appendix rates are within the control of the hospital or doctor and that high rupture rates reflect a failure of medical care, writes Ponsky. Ruptured appendix rates are even used as a measure of hospital quality.
Because appendicitis can be difficult to diagnose, the procedure in most hospitals is to perform exploratory surgery (called negative appendectomy when the appendix is fine). Nevertheless, despite efforts by hospitals to intervene early, the rupture rate remains high among children -- ranging from 30% to 74%. Possibly, kids aren't getting to the hospital soon enough, he writes.
In their study, Ponsky and his colleagues reviewed medical records on 24,411 appendix surgeries performed on children aged 5 to 17 at 36 pediatric hospitals across the U.S. over a five-year period.
They sifted the data, finding:
- A 3% negative appendectomy rate
- A 35% overall rate of ruptured appendix
- A 66% higher rate of ruptured appendix in Asian children and a 13% higher rate in black children compared with white children
- A 36% higher rate of ruptured appendix in uninsured children and a 48% higher rate in Medicaid-covered children compared with private insurance-covered children
The children are likely not getting medical attention when needed. When they do get medical care, it's not always not good quality, writes Ponsky. Also, symptoms of appendicitis are more difficult to recognize in younger children - a well-established fact.
Earlier studies have found similar a pattern, that ruptured appendix often happens before arrival at the emergency room door. Delays in recognizing appendicitis doubled the rupture rate.
To solve the problem, these kids need better access to medical care. Also, hospitals must perform more exploratory surgeries. "The excessively high rates of [ruptured appendix] in children should no longer be tolerated," he writes.