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Objectives: Our goal was to examine factors associated with the administration of emergency department analgesia (any analgesia, opioid analgesia) in patients with acute appendicitis in a tertiary children's hospital in Israel, and to examine ethnic differences., Methods: A retrospective cohort study of children evaluated in the emergency department, who had International Classification Of Disease-Ninth Revision (ICD-9) diagnosis of acute appendicitis. Regression analysis was used to test the effect of multiple variables on the provision of analgesia. Medications were administered according to a nurse-driven pain protocol. Multivariate regression was performed to estimate the strength of association between ethnicity and provision of analgesia. The effect of patient-nurse ethnicity concordance was assessed., Results: During the 6-year study period, there were 715 children with acute appendicitis, 457 Jews and 258 Arabs. Overall, 289 (40.4%) received some form of analgesia, and 139 (19.4%) received opioid analgesia. Univariate analysis revealed that higher pain score (P<0.001) and higher triage acuity (P<0.001) were associated with administration of any type of analgesia and of opioid analgesia. When adjusted for age, weight, sex, triage category, pain score, and 24-hour time of arrival, Jewish and Arab patients had similar likelihood of receiving analgesia of any type 41.8% (95% confidence interval [CI], 40.3%-43.3%) versus 40.7% (95% CI, 38.7%-42.8%), and receiving opioid analgesia 26.1% (95% CI, 24.4%-27.8%) versus 25.3% (95% CI, 22.9%-27.7%). Similar proportions of Jewish and Arab patients received analgesia from Jewish and Arab nurses., Conclusions: Low rates of analgesia and opioid administration were found with no ethnic differences.

Objective: The objective of this study was to determine the relationship of race and socioeconomic factors and the method used for appendectomies in children (open vs. laparoscopic)., Summary Background Data: Previous studies have shown racial and insurance-related differences associated with the management of appendicitis in adults. It is not known whether these differences are observed in children., Methods: Children (<15 years) undergoing appendectomy from 1996 to 2002 were identified in the Nationwide Inpatient Sample. Severity of appendicitis and underlying chronic illnesses were determined by ICD-9 codes. Hospital characteristics evaluated included teaching status and location, children's hospital status, and volume of appendectomies. Hierarchical unadjusted and risk-adjusted logistic regression analyses were performed., Results: Among 72,189 children undergoing an appendectomy for appendicitis, 11,714 (16%) underwent a laparoscopic appendectomy. Multivariate analysis showed that whites were more likely to undergo a laparoscopic appendectomy than blacks (odds ratio, 1.14; 95% CI, 1.03-1.25, P = 0.01) but not other races. A significant interaction between payer source and children's hospital designation was observed, with the odds of children with private insurance undergoing laparoscopic appendectomy being significantly higher than those without private insurance at nonchildren's hospitals but not at children's hospitals., Conclusions: There are significant racial and insurance-related differences in use of laparoscopic appendectomy in children that are most evident at nonchildren's hospitals. These findings provide evidence that factors at hospitals dedicated to children may lead to better access to new technologies.

In an attempt to explore the possible variation over time of acute appendicitis (AA) 406 medical files comprising all children aged 0-14 years operated on during an 11-year period (1973-1983) at the Soroka Medical Center were reviewed. Only patients that were histopathologically confirmed were included in the study. Soroka Medical Center is the only general hospital providing services to the entire population of the region. Hence, a reasonable coverage of all AA patients is expected. As a result, comparison of incidence rates among different subgroups is plausible. The annual rate of AA was 3.75 operations/10,000 children. The rates were somewhat higher for boys (5.20 versus 2.31, p less than 0.05). They were also higher for Jewish versus Bedouin children (4.44 versus 1.14, p less than 0.05). The highest rate of AA was among children in the 10- to 14-year-old age group (7.79). A gradual increase in the rates of AA during the study period was noticed, over and above the increase in the region's population. However, the ratio of change over time was higher for the Bedouins. Although this cannot be proven, the causes of AA have been hypothesized to be multifactorial. Diet is considered to have an important role in the etiology of AA. Some seasonal trends could be observed, paralleling changes in humidity, viral and bacterial infections, suggesting the involvement of these factors in the etiology of AA.