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Deprivation increases perforation risk in paediatric appendicitis
  1. Ross Bogle1,
  2. Rachel McIntyre1,
  3. Neil Patel2,
  4. Timothy John Bradnock3
  1. 1 Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
  2. 2 Department of Neonatology, Royal Hospital for Children, Glasgow, UK
  3. 3 Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, UK
  1. Correspondence to Dr Ross Bogle, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow G12 0XH, UK; ross.bogle{at}


Acute appendicitis is the most common surgical emergency in childhood. Perforation of the appendix conveys a worse outcome.

This case–control study investigated the relationship between deprivation and appendiceal perforation in children in the West of Scotland.

All children undergoing acute appendicectomy over a 2-year period were identified. Basic demographics including Scottish Index of Multiple Deprivation (SIMD) rank and clinical features including time to presentation and surgical findings were recorded. Associations were investigated using multivariable analysis.

304 patients (62% male) underwent appendicectomy. Mean age was 10.4 years (SD ±3.5). Mean time from symptom onset to presentation was 2.3 days (SD ±2.5). Perforation rate was 44.41%.

Perforation was associated with lower age (p=0.004, OR −0.10, 95% CI −0.17 to −0.33), increased time to presentation (p=0.044, OR 0.14, 95% CI 0.004 to 0.27) and SIMD tertile (p=0.027, OR 0.63, 95% CI 0.07 to 1.20). SIMD tertile was not associated with delayed presentation.

Worsening deprivation independently predicts perforation, but this relationship is not mediated through a delay in presentation.

  • paediatric surgery
  • epidemiology

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  • Contributors RB and RM conceived the original idea and set up the project. RB and RM gathered data for the project. NP conducted statistical analysis of the data and helped supervise the study. RB took the lead in writing the manuscript with input from all authors. TJB supervised the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are stored on an Excel sheet stored within computer systems on the NHS Greater Glasgow and Clyde system. Data are available upon request to RB (