Background:
Recent studies have shown a higher incidence of complications from acute appendicitis in Hispanic populations. Ladd et al. demonstrated increased rates of complications in Hispanic children. Some authors purport that while controlling for confounders, Hispanic ethnicity alone was a risk factor for complications. In contrast, three statewide studies recently found little evidence of racial disparities in perforated acute appendicitis rates.
Study Aims:
To compare the use of computed tomography (CT) scan in the diagnosis of pediatric acute appendicitis between Hispanic vs. non-Hispanic populations when ultrasound (US) is indeterminate.
Methods:
This is a retrospective cohort study of patients age 2-18 who presented to the pediatric emergency department with right lower quadrant abdominal pain in our institution over a one-year period. Overall study subjects were divided into Hispanic and non-Hispanic patients. Both groups were subdivided into those with positive, negative, or indeterminate US findings for appendicitis. We analyzed each subgroup based on those who had further radiological imaging (CT) done.
Results:
A total of 471 ultrasounds were performed to evaluate for acute appendicitis, 162 (Hispanic children) and 309 (non-Hispanic children). 90/162 (56%) of Hispanic patients vs. 155/309 (50%) of non-Hispanic patients had indeterminate US scans. 27/90 (30%) of Hispanic patients with indeterminate scans vs. 50/155 (32%) of non-Hispanic patients with indeterminate scans received CT scans. Of the 27 Hispanic patients that received CT scans, 7/27 (26%) were positive for appendicitis, 17/27 (63%) negative, 3/27 (11%) indeterminate. Of the 50 non-Hispanic patients that received CT scans, 12/50 (24%) were positive, 31/50 (62%) negative, 7/50 (14%) indeterminate. Chi Sq. analysis comparing the proportion of CT scans received for indeterminate US scans between both groups showed no statistical significance. χ2 (1, N=245) = 0.135, p=0.71. 54/162 (33%) of Hispanic patients vs. 102/309 (33%) of non-Hispanic patients had negative US scans. 4 of 54 Hispanic patients with negative US scans received CT scans and all had negative results. Chi Sq. analysis comparing the proportion of CT scans received for negative US scans between both groups also showed no statistical significance. χ2 (1, N=156) = 0.401, p=0.52.
Limitations:
Our study was a retrospective chart review of an administrative database and our analysis depends on the integrity of the clerical data entry. In addition, this study analyzed data from a single pediatric institution and may not be generalizable to other settings.
Conclusions:
There was no significant difference in the number of CT scans ordered for indeterminate US scans between Hispanic and non-Hispanic populations. From this study, one can infer that there is not an inherent bias toward ordering advanced imaging in Hispanic children based on ethnicity alone.
