Episode 15 - Paediatrics: Part 1 - Racial Disparities In Healthcare

Theme: Paediatrics.

Participants:

Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Yelise Foon, Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda Wilegoda

Discussion:
Goyal, M., Chamberlain, J., Webb, M., Grundmeier, R., Johnson, T., & Lorch, S. et al. (2020). Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Academic Emergency Medicine, 28(9), 949-956. https://doi.org/10.1111/acem.14142.

Presenter: Yelise Foon.

Summary:

• Delay in the diagnosis of appendicitis is associated with perforation and significant subsequent morbidity.
• Currently the pre-operative perforation rate for appendicitis is 30%.
• Some known risk factors for a delayed diagnosis for appendicitis include a young age, female gender, African-American race, non-English speaking backgrounds and government insurance factors (predominantly in the US).
• This was a multi-centre retrospective cohort study conducted over 3 years utilizing the PECARN registry, which aimed to compare the rate of appendiceal perforation, delayed diagnosis of appendicitis and diagnostic imaging use among different ethnicities.
• Of the 7298 children diagnosed with appendicitis where race/ethnicity data was collected, 34.9% of non-Hispanic white children had a perforated appendix, compared with 36.5% of non-Hispanic black children.
• Non-Hispanic black children also had higher rates of delayed diagnosis (defined as having a relevant emergency visit in the week prior to diagnosis): at 4.7% compared with 2.0% for non-Hispanic white children.
• Further non-Hispanic black children with a delayed diagnosis of appendicitis were less likely to undergo definite imaging (including MRI, ultrasound, or CT) compared with their non-Hispanic white counterparts (with 28.2% versus 46.2% undergoing imaging).
• However, given that this study came out of the US, the generalisability of this study to Australian emergency departments is unclear.
• Health literacy is likely to be a large contributor to delayed presentation of appendicitis and something to be carefully considered when treating any child (and their family).
• There are tools such as the Paediatric Appendicitis Score (PAS) and the Alvarado Score which may assist in objectively quantifying the possibility of appendicitis (particularly for junior staff).

Take-Home Points:

• It is important for us to consider how we can minimise racial and ethnic disparities and make sure we are conscious of them.

Credits:
This episode is produced with help of HETI's Emergency Medicine Training Network 5.

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See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.

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