ROLE OF THE PRIMARY-CARE PROVIDER IN EXPEDITING CARE OF CHILDREN WITHACUTE APPENDICITIS

Objective: To assess the role of the primary care provider (PCP) in th e diagnosis and treatment of acute appendicitis in children by determi ning whether there were differences in the treatment and outcome of ch ildren whose parents contacted the PCP before taking the child to the hospital compared with those who did not. Design: Retrospective review of medical records of pediatric patients discharged from the hospital with the diagnosis of acute appendicitis. Setting: An urban children' s hospital. Methods: The medical records of children treated for acute appendicitis from July 1, 1990, through June 30, 1994, were identifie d through review of hospital discharge data and divided into 2 groups based on whether the children's parents had contacted the PCP before t heir arrival at the hospital. Contact with the PCP was determined by r ecord review or telephone interview with the parent. The 2 groups were then studied for differences in treatment and outcome. Statistical an alysis was by the chi(2) test and the Student t test, as appropriate, with the level of significance determined at P<.05. Results: During th e 4-year period, 343 children underwent appendectomy. Medical records were available for review for 321 children (94%). After review, record s of 38 children were excluded because the primary problem was not acu te appendicitis. Of the 283 children whose records were included in th e study, the parents of 160 had contacted the PCP before arrival at th e hospital (group 1, those who called) and the parents of 99 had not c alled (group 2, those who did not call). It could not be determined wh ether a call had been made for 24 children. The mean age of the childr en in group 1 was 124 months and in group 2 was 126 months (P=.74). Of group 1, 24% arrived at the hospital on a Saturday or Sunday, compare d with 40% of group 2 (P=.007). Children in group 1 who arrived at the hospital during the weekend were operated on a mean (SD) of 4.7 hours (3.7 hours) after arrival at the hospital, compared with 10.6 hours ( 17.1 hours) for children in group 2 (P=.04). The mean (SD) interval be tween arrival at the hospital and operation on weekdays (Monday throug h Friday) was similar in both groups: 12 hours (20.6 hours) in group 1 and 13.7 hours (25.6 hours) in group 2 (P=.63). Appendiceal perforati on was less likely in children in group 1 (62/160 [39%]) than in those in group 2 (53/99 [54%]; P=.03). Parents of 50 (89%) of 56 children w ho belonged to a health maintenance organization called the PCP compar ed with 96 (62%) of the 156 with fee-for-service insurance and 10 (26% ) of the 38 with Medicaid (P<.001). No difference was noted in the int erval between arrival at the hospital and operation or incidence of ap pendiceal perforation according to type of insurance. Conclusions: Chi ldren with appendicitis whose parents contacted the PCP before arrival at the hospital were less likely to have appendiceal perforation than those whose parents did not call the PCP, irrespective of insurance s tatus. Children whose parents called the PCP before arrival at the hos pital during the weekend were operated on more promptly than were chil dren whose parents did not call the PCP. Contact with the PCP was asso ciated with more expeditious care of children with acute appendicitis.