Appendicitis in northern aboriginal children: does delay in definitive treatment affect outcome? Alana Beres, Saleh Al-Abbad, Pramod S. Puligandla ⁎ Division of Pediatric General Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada H3H1P3 Received 23 January 2010; accepted 2 February 2010 Key words: Appendicitis; Outcome; Aboriginal populations; Appendiceal perforation Abstract Background: The treatment of northern aboriginal children (NAC) is often complicated by distance from a treating facility. We sought to compare outcomes of NAC requiring transfer with appendicitis to those who presented locally. We hypothesized that NAC with appendicitis experienced higher rates of perforation and increased length of stay (LOS). Methods: A retrospective chart review of 210 appendectomies was performed. Charts were reviewed for age, sex, weight, days of symptoms before presentation, time of transfer, leukocyte count (white blood cell count), usage of antibiotics prior to transfer, time to operation, type of procedure and findings, pathology, postoperative outcomes, and LOS. Results: Sixty-eight children were NAC, whereas 142 were local. The average transfer times for NAC was 10 hours (range, 4-20 hours). The two groups had similar ages (11.1 vs 10.7 years), time to presentation (1.64 vs 1.85 days), and LOS (2.91 vs 2.90 days). Significantly higher perforation rates (44 vs 28%; P = .02), higher white blood cell count (17.9 vs 16.0; P = .02), and longer times to operation after arrival (10.3 vs 7.0 hours; P = .0002) were noted in NAC. Postoperative complications were similar between groups. Forty-seven (69%) NAC received antibiotics prior to transfer, which did not affect rate of rupture. Conclusion: NAC with appendicitis experience longer transfer times and higher perforation rates than local children without a difference in length of stay or complications. Pretransfer antibiotics do not reduce perforation rates but may impact complications. We endorse their use if a delay in transfer is anticipated. © 2010 Elsevier Inc. All rights reserved. Appendicitis remains the most common surgical emer- gency in children [1-3]. Although the reported rates of perforation for appendicitis vary widely, ranging from 20% to 76% [2,4,5], it is generally accepted that delays in diagnosis and treatment lead to higher rates of perforation and postoperative complications. This may be a particularly pertinent problem affecting northern aboriginal children (NAC) who often suffer long delays in the comprehensive management of appendicitis because of their remote location, long transport times, and lack of physician coverage. The goal of this study was to compare the outcomes of NAC with a diagnosis of appendicitis to children presenting from local populations. Presented at the 41st Annual Meeting of the Canadian Association of Paediatric Surgeons, Halifax, Nova Scotia, Canada, October 1-3, 2009. ⁎ Corresponding author. Tel.: +1 514 412 4438; fax: +1 514 412 4289. E-mail address: pramod.puligandla@mcgill.ca (P.S. Puligandla). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2010.02.008 Journal of Pediatric Surgery (2010) 45, 890–893