Impact of Initial Healthcare Setting and Family Caregiving Structure on Pediatric Appendicitis Outcomes in Resource-Limited Settings: A 10-Year Retrospective Cohort Study with External Validation

Acute appendicitis is a common pediatric surgical emergency worldwide. Misdiagnosis and perforation remain frequent, particularly among younger children in low- and middle-income countries. Prior studies have explored healthcare access or caregiving structures separately, but few long-term, large-sample retrospective studies in resource-limited settings have assessed their combined impact.