Variation in the Diagnosis and Management of XXXX at Canadian Pediatric Hospitals.

@entity1 @entity698
OBJECTIVES: The objective was to characterize the variations in practice in the diagnosis and management of @entity1 admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected @entity698 , specifically the timing of surgical intervention, ED investigations, and management strategies. METHODS: Twelve sites participated in this retrospective health record review. @entity1 aged 3 to 17  years admitted to the hospital with suspected @entity698 were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with after-hours surgery were determined using generalized estimating equations logistic regression. RESULTS: Of the 619 @entity1 meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 @entity1 , with significant variation across sites (13.9%, 95% confidence interval  =  7.1% to 21.6%, p  <  0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p  =  0.004 and p  =  0.036, respectively). Use of inflammatory markers (p  <  0.001), blood cultures (p  <  0.001), ultrasound (p  =  0.001), and computed tomography (p  =  0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p  <  0.001 and p  =  0.001, respectively), as did the type of surgical approach (p  <  0.001). After-hours triage had a significant inverse association with after-hours surgery (p  =  0.014). CONCLUSIONS: Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of @entity1 with suspected @entity698 . These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal @entity1 outcomes.
