Fewer pediatricians, more ruptured appendixes

NEW YORK (Reuters Health) - Children who live in areas with plenty of pediatricians may get more timely diagnosis and treatment of appendicitis, and therefore be at lower risk of a rupture, a new study suggests.

The number of pediatricians in the area may be even more vital than the supply of surgeons, the researchers conclude. Pediatricians, along with other primary care providers, are currently in short supply around the country.

And one in 15 people in the U.S. will get appendicitis, an inflammation of the appendix that often requires its removal. (People can live just fine without the small tube of tissue attached to the large intestine.)

Appendicitis typically strikes between the ages of 2 and 30, and brings with it intense abdominal pain and fever.

About one of every three inflamed appendixes in children will end up bursting and spilling infectious material. These patients will typically stay in the hospital longer, pay higher costs and will be at an increased risk of additional complications.

“Although we don’t know the specifics of the progression, if appendicitis is ignored, over time it can progress to a ruptured appendix,” senior researcher Dr. Fizan Abdullah, of the Johns Hopkins Children’s Center in Baltimore, told Reuters Health.

Abdullah and his colleagues used the National Inpatient Sample database and the Kids’ Inpatient Database from 1988 to 2005 to look at more than a quarter-million U.S. children under the age of 18 with appendicitis. About a third of the cases involved a rupture.

The researchers then analyzed the cases, examining whether a variety of different health care system characteristics had any influence on whether or not an inflamed appendix would burst.

After adjusting for factors such as the patient’s age, insurance status and household income, they found that children with appendicitis who lived in an area with the highest pediatrician density - or at least higher than three quarters of their peers - had a 12 percent lower risk of suffering a rupture than children in areas with the lowest density of pediatricians.

“We could further hypothesize that children in specific counties that had easier access to pediatricians were more quickly fast-tracked into the emergency room or hospital where a surgeon was then able to treat them,” added Abdullah.

The density of hospitals, emergency room doctors or diagnostic imaging machines in the child’s area, on the other hand, did not appear to affect the chances of a rupture, report the researchers in the Archives of Surgery. Even the number of local surgeons did not seem to matter.

“These findings suggest that the specific locality or density of surgeons is not as important as the first line of defense: pediatricians,” said Abdullah.

Abdullah noted that the findings could be applied to a range of conditions, including other abdominal ailments, as well as tumors and traumatic injuries.

“The implications in terms of the health care system and how it manages patients with surgical disease is striking,” he said.

Abdullah also pointed to the “very acute and dire shortages” of primary care physicians and emphasized the need to recognize and appreciate the providers that play an important role in taking care of children.

A study published Monday found that pediatricians are in short supply nationwide but also very unevenly distributed, resulting in millions of kids living in areas served by one pediatrician for every 4,000 children or more. (See Reuters Health story of December 21, 2010, here.)

As for parents, Abdullah advised that “if a child is having severe abdominal pain and fever, it is something that is worthy of evaluation so that more serious diseases can be ruled out.”

SOURCE: Archives of Surgery, online December 20, 2010.