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

In this episode, we discuss rates of delayed diagnosis of appendicitis and its complications across various racial groups. The interlude segment will be presented by paediatric emergency physician, Dr Karl Pobre.
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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