Outcomes of Pediatric Appendicitis An International Comparison of the United States and Canada
Bibliographic record
Abstract
he United States and Canada have very different health care delivery systems.The United States has a multipayer system consisting of a large number of private insurers and multiple public programs.In 2011, 48.6 million people in the United States, including approximately 9 million children, were uninsured, representing 15.7% of the population. 1 Canada provides universal, publicly funded, single-payer health insurance to all citizens and legal residents.Waits for evaluation and treatment of a variety of medical conditions are part of the Canadian medical landscape.In 2011, 2.8% of all Canadians waited for an estimated 941 321 procedures. 2 Beyond insurance coverage and waiting times, the differences between the United States and Canada impact multiple aspects of health care, including physician and hospital reimbursement, administrative overhead, billing prac-tices, medical malpractice, and availability of medical resources.Patients, as well as physicians, are profoundly affected by all of these areas.Several previous studies have looked at outcome differences between the United States and Canada for a variety of diseases, both acute and chronic.A systematic review of 38 studies showed that most favored Canada or showed no differences between the 2 countries.3 Most of these studies analyzed adult diseases or combined adult and pediatric populations.3 To our knowledge, no previous studies have specifically looked at pediatric surgical outcomes.Appendicitis is the most common pediatric surgical emergency, and appendectomy is the most common urgent pediatric surgical operation.The outcomes of appendicitis are largely dependent on the severity of the disease at presenta-IMPORTANCE Pediatric appendicitis outcomes have been shown to be influenced by several patient-, surgeon-, and hospital-level factors.However, to our knowledge, no prior studies have investigated the effect of health care systems on outcomes.OBJECTIVE To test the hypothesis that the outcomes of children with appendicitis are better in the Canadian single-payer universal health care system than in the US multipayer system. DESIGN, SETTING, AND PARTICIPANTSA population-based comparison of outcomes using the US Kids' Inpatient Database and the Canadian Discharge Abstract Database was performed.Subanalyses by age group, US insurance status, and severity of appendicitis (nonperforated or perforated) were also performed.We included patients younger than 18 years coded for nonincidental, urgent appendectomy in the 2006 and 2009 Kids' Inpatient Database (78 625) and 2004 to 2010 Discharge Abstract Database (41 492). MAIN OUTCOMES AND MEASURESPerforation rate, normal appendix rate, and length of hospital stay. RESULTSCanadian patients had higher rates of normal appendix (6.3% vs 4.3%; P < .001)and perforated appendicitis (27.3% vs 26.7%; P = .04).The Canadian perforation rate fell in the middle between privately insured (24.1%) and publicly insured or noninsured US patients (30.4% and 31.2%,respectively).The Canadian perforation rate was lower in the 0-to 5-year age group (47.7% vs 52.3%; P < .001)and higher in the 12-to 17-year age group (24.7% vs 21.8%; P < .001)vs US patients.In Canada, hospital stay was longer after simple appendicitis (mean [SD], 2.0 [1.2] vs 1.7 [1.2] days; P < .001)and shorter after perforated appendicitis (mean [SD], 4.8 [3.6] vs 5.3 [3.7] days; P < .001). CONCLUSIONS AND RELEVANCEDifferences in outcomes of pediatric appendicitis between the United States and Canada are influenced by age and US insurance status.These differences are relevant to health policy decisions in both nations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".