关键词: 急性阑尾炎, 求医方式, 首诊, 转诊, 卫生经济学, 儿童

Abstract:  Objective: To explore the influence of different ways to seek medical help（first visit or referral）on health economics of
acute appendicitis in children. Methods: 292 children with acute appendicitis were divided into four groups according to the ways to
seek medical help（first visit or referral）in the First Affiliated Hospital of Dali University from January 2013 to December 2016. In
Group 1, there were 79 cases of the first visit; in Group 2, there were 137 cases of referral for once; in Group 3, there were 66 cases of
referral for twice; and in Group 4, there were 10 cases of referral for at least three times. The values including the time period of disease
course, ratio of appendiceal perforation and postoperative complications, duration and cost of hospitalization were compared and
analyzed with t-Test, χ 2 and Logistic in different groups. Results: From Group 1 to Group 4, relevant data was: ① disease course
（36.27±24.85）h,（57.05±40.53）h,（95.10±63.29）h and（105.60±27.36）h; ② the ratio of appendiceal perforation 17.72%, 38.69%,
53.03% and 90.00%; ③ the ratio of postoperative complications 2.53%, 14.60%, 24.24% and 80.00%; ④ hospital days（6.82±2.54）
d,（8.78 ±4.32）d,（12.03±5.27）d and（18.00±8.60）d; ⑤ hospital costs（RMB 3 927.66±945.46）,（RMB 4 563.03±1 217.61）,（RMB
6 056.31±1 909.70）and（RMB 9 802.49±2 551.49）respectively. From the first diagnosis to the referral and multiple referrals, there
were significant increases in all indicators. Except for the difference in disease course between Group 3 and Group 4（P>0.05）, there
were statistically significant differences among other indicators between different groups（P<0.05）and there was a positive correlation
between different indicators（P=0.000）. Logistic regression was P<0.05. Conclusion: Hospital costs increased in children with acute
appendicitis due to the increase of the appendiceal perforation rate, the postoperative complications rate and the length of hospital stay
with the prolong of illness course because of the different option for seeking medical help ways from first visit to one or more times of
referrals. It is suggested that the children with acute appendicitis should be treated in the first hospital as far as possible and avoid
times of referral because it is beneficial to them on shorten the length of disease and hospital days and reduce medical costs.

Key words:  acute appendicitis, the ways to seek medical help, first visit, referral, health economics, children