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Context The rates of appendiceal rupture and negative appendectomy in children remain high despite efforts to reduce them. Both outcomes are used as measures of hospital quality. Little is known about the factors that influence these rates. Objective To investigate the association between hospital- and patient-level characteristics and the rates of appendiceal rupture and negative appendectomy in children. Design, Setting, and Patients Retrospective review using the Pediatric Health Information System database containing information on 24,411 appendectomies performed on children aged 5 to 17 years at 36 pediatric hospitals in the United States between 1997 and 2002. Main Outcome Measures Rates of negative appendectomy and appendiceal rupture; the odds ratio (OR) of negative appendectomy and appendiceal rupture by hospital, patient age, race, and health insurance status, and hospital fiscal year and appendectomy volume. Negative appendectomy rate was defined as the number of patients with appendectomy but without appendicitis divided by the total number of appendectomies. Results The median negative appendectomy rate was 3.06% (range, 1%-12%) and the median appendiceal rupture rate was 35.08% (range, 22%-62%). The adjusted OR for appendiceal rupture was higher in Asian children (1.66; 95% confidence interval [CI], 1.24-2.23) and black children (1.13; 95% CI, 1.01-1.30) compared with white children. Children without health insurance and children with public insurance had increased odds of appendiceal rupture compared with children who had private health insurance (adjusted OR, 1.36; 95% CI, 1.22-1.53 for self-insured; adjusted OR, 1.48; 95% CI, 1.34-1.64 for public insurance). No correlation existed between negative appendectomy rate and race, health insurance status, or hospital appendiceal rupture rate. The negative appendectomy rate improved as the hospital appendectomy volume increased. Conclusion The rate of appendiceal rupture in school-aged children was asso... [ABSTRACT FROM AUTHOR]

Objective. Children are safest when traveling in a child safety seat appropriate for their age and size. Previous research indicates that children are often transitioned to shield booster seats (SBSs) before reaching the 40-lb weight limit for their forward-facing child safety seat (FFCSS). These children could have otherwise been restrained in a FFCSS as is currently recommended by the American Academy of Pediatrics and the National Highway Traffic Safety Administration. The objective of this study was to compare the injury patterns among children who were restrained in SBSs and FFCSSs. Children in FFCSSs were chosen as a comparison group because SBS are predominately used to restrain children who are < 40 lb and could have been restrained in an FFCSS, and SBSs are no longer certified for use in children who are > 40 lb. Methods. This is a cohort study involving restrained crash victims who were admitted to a level 1 pediatric trauma center between 1991 and 2003. Patients were older than 1 year, weighed between 20 and 40 lb, and were restrained in an SBS (N = 16) or an FFCSS (N = 30). Injury Severity Score, Abbreviated Injury Scale, Glasgow coma score, intensive care admission, length of stay, and acute care charges served as outcomes of interest. Results. No significant differences regarding crash and occupant characteristics were found (mean Delta V, crash type, passenger compartment intrusion, driver restraint use). Odds of severe injury were greater for children in SBSs compared with children in FFCSSs as measured by Injury Severity Score > 15 (odds ratio [OR]: 8.3; 95% confidence interval [CI]: 2.1-33.6), intensive care admission (OR: 5.5; 95% CI: 1.5-20.5), length of stay > 2 days (OR: 6.3; 95% CI: 1.6-24.6), and Abbreviated Injury Scale > 3 (OR: 4.4; 95% CI: 1.2-16.1). Furthermore, SBS cases had greater odds of head (OR: 4.5; 95% CI: 1.2-17.3), chest (OR: 29.0; 95% CI: 3.1-267.3), and abdominal/pelvic injury (25% vs 0%). Conclusion... [ABSTRACT FROM AUTHOR]