Abstract
Purpose
The present study aimed to determine whether children with perforated appendicitis were more likely to present during specific days of the week or seasons of the year.
Methods
After obtaining IRB exemption, a retrospective, population-based study of patients <18 with ICD9 codes of acute (540.9) or perforated (540.0, 540.1) appendicitis in the Kids’ Inpatient Database (KID) was performed. Univariate and multivariate analyses were performed analyzing patient and hospital factors.
Results
A total of 31,457 children were identified with acute appendicitis, of whom 10,524 (33.5%) were perforated. Mondays [odds ratio (OR): 1.16; 95% Confidence Interval (CI): 1.05−1.28] were significant for increased likelihood as day of presentation with perforation in US children more than any other day of the week. In seasonal analysis, fall (OR: 1.12; 95% CI: 1.04−1.21) and winter (OR: 1.11; 95% CI: 1.03−1.20) were at higher odds for perforation at presentation. Patients with Medicaid (OR: 1.22; 95% CI: 1.03−1.43) and those uninsured (OR: 1.50; 95% CI: 1.16−1.93) were more likely to present with perforation.
Conclusion
Perforated appendicitis was more likely to present on Mondays in US children. Although appendicitis is most common in summer months, rates of perforated appendicitis were highest in fall and winter.
Similar content being viewed by others
References
Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925
Morrow SE, Newman KD (2007) Current management of appendicitis. Semin Ped Surg 16:34–40
Eldar SE, Nash E, Abrahamson J et al (1997) Delay of surgery in acute appendicitis. Am J Surg 173:194–198
Van der Palen J, Doggen CJ, Beaglehole R (1995) Variation in the time and day of onset of myocardial infarction and sudden death. N Z Med J 108:332–334
Willich SN, Lowel H, Keil U et al (1994) Weekly variation of acute myocardial infarction - increased Monday risk in the working population. Circulation 90:87–93
Arntz HR, Willich SN, Schultheib HP et al (2000) Diurnal, weekly and seasonal variation of sudden death. Eur Heart J 21:315–320
Bratton SL, Haberkern CM, Waldhausen JH (2000) Acute appendicitis risks of complications: age and Medicaid insurance. Pediatrics 106:75–78
Korner H, Sondenaa K, Soreide JA et al (1997) Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg 21:313–317
Luckmann R, Davis P (1991) The epidemiology of acute appendicitis in California, racial, gender, and seasonal variation. Epidemiology 2:323–330
Wolkomir A et al (1987) Seasonal variation of acute appendicitis: a 56 year study. South Med J 80:958–960
Al-Omran M, McLeod R et al (2003) Epidemiologic features of the acute appendicitis in Ontario, Canada. Can J Surg 46:263–268
HCUP (2002) HCUP KIDS’ inpatient database design report 1997. Agency for Health Care Research and Quality, Rockville, MD
Kokoska ER, Minkes RK, Silen ML et al (2001) Effects of pediatric surgical practice on the treatment of children with appendicitis. Pediatrics 107:1298
Braveman P, Schaaf M, Egerter S, Bennett T, Schecter W (1994) Insurance-related differences in the risk of ruptured appendix. N Engl J Med 331:444
Gadomski A, Jenkins P (2001) Ruptured appendicitis among children as an indicator of access to care. Health Serv Res 36:129–142
Brender JD, Marcuse ED, Koepsell TD, Hatch EI (1985) Childhood appendicitis: factors associated with perforation. Pediatrics 76:301–306
Vehvilainen AT, Kumpusalo EA, Takala JK (1999) They call it stormy Monday–reasons for referral from primary to secondary care according to the days of the week. Br J Gen Pract 49:909–911
Bickell NA, Siu AL (2001) Why do delays in treatment occur? Lessons learned from ruptured appendicitis. Health Serv Res 36: 129–42
Brumer M (1970) Appendicitis: seasonal incidence and postoperative would infection. Br J Surg 57:93–99
Tobe T (1965) Inapparent virus infection as a trigger of appendicitis. Lancet 1:1343–1346
Newman K, Ponsky T, Kittle K et al (2003) Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg 38:372–379
Andersson R (2007) The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg 31:86–92
Schweitzer J, Fairman N, Schreyer K, Waxman K (2003) Appendicitis, 2002: Relationship between payors and outcome. Am Surg 69:902–908
Ponsky T, Huang Z, Kittle K, Newman KD et al (2004) Hospital- and patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children. JAMA 292:1977–1982
Nwomeh BC, Chisolm DJ, Caniano DA, Kelleher KJ (2006) Racial and socioeconomic disparity in perforated appendicitis among children: where is the problem? Pediatrics 117:870–875
Smink D, Fishman S, Kleinman K, Finkelstein J (2005) Effects of Race, insurance status, and hospital volume on perforated appendicitis in children. Pediatrics 115:920–923
Guagliardo MF, Teach SJ, Joseph JG et al (2003) Racial and ethnic disparities in pediatric appendicitis rupture rate. Acad Emerg Med 10:1218–1227
Kokosa ER, Bird TM, Campbell BT et al (2007) Racial disparities in the management of pediatric appendicitis. J Surg Res 137:83–88
Alloo J, Gerstle T, Shilyansky J, Ein SH (2004) Appendicitis in children less than 3 years of age: a 28 year review. Ped Surg Int 19:777–779
Lee SL, Ho HS (2006) Acute appendicitis: is there a difference between children and adults? Am Surg 72:409–413
Acknowledgments
The authors would like to extend their appreciation to the Robert Garrett Fund for the Surgical Treatment of Children for support of this study and Leilani Sharpe for her review of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Deng, Y., Chang, D.C., Zhang, Y. et al. Seasonal and day of the week variations of perforated appendicitis in US children. Pediatr Surg Int 26, 691–696 (2010). https://doi.org/10.1007/s00383-010-2628-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-010-2628-z