P2.P305: Impact of Family Experiences on Acute Appendicitis Care in Children

Background: Disparities in care in children undergoing surgery have been identified in many conditions, although the specific drivers of these disparities are not fully understood. We are conducting a multicenter clinical trial for children with appendicitis to identify family-level factors which drive surgical care. In this pilot sub-study of this trial, we examined how family dynamics around their child’s pain impact delays in care (perforation rates) and clinical outcomes for appendicitis.

Methods: Participants included caregivers of children < 18 years old with appendicitis across two different study site hospitals. Parents completed the Adult Responses to Children’s Symptoms (ARCS) survey. Our main outcome included overall ARCS scores, as well as sub-analysis by domains including protect, minimize, distract, and monitor. Children aged < 8 years old also completed the child version of the ARCS survey. Demographic information (including race, ethnicity, and number of dependents) was provided by the parents and data from the hospital stay (imaging modalities, medications given, time to discharge) were collected via Epic. A logistic regression model was used to confirm associations between overall ARCS scores as well as each subdomain's scores with the rate of perforated appendicitis (outcome variable). Cohen’s f was calculated to estimate effect size given the early stage of enrollment (30% of goal).

Results: Preliminary analysis (n=36) shows a negative correlation between the Protect domain of the ARCS survey and perforation rates (p=0.258; Cohen’s f = 0.19; moderate effect size). Similarly, the Minimize domain shows a positive correlation with perforation rate (p=0.084; Cohen’s f = 0.33; moderate effect size). Strong associations with perforation were not observed for the Monitor (p=0.739; Cohen’s f = 0.06) and Distract (p=0.813; Cohen’s f = 0.04) domains, which could be due to small number of questions or weak associations as previously noted in the literature.

Conclusion: Our early results suggest the importance of family dynamic and communication of pain as potential drivers of delays in care for children with appendicitis. These findings suggest possible roles for providers to focus their education to families to improve care of children with appendicitis.