Original scientific articleHow Time Affects the Risk of Rupture in Appendicitis
Section snippets
Study design and setting
This study was part of a larger project designed to assess the relationship between time of symptom duration and health outcomes among three conditions and to determine causes of potential delays in care. The first phase of the study involved retrospective identification of approximately 200 patients with each condition from patients seen at two inner-city hospitals. One hospital is a 1,171-bed tertiary referral center; the other is a 450-bed municipal teaching hospital. This article reports
Factors associated with appendiceal rupture
Patient demographic and clinical characteristics by rupture group are listed in Table 1. Two-thirds of the population were between the ages of 21 and 64 years. Fifty-two percent were women and 64% were non-Caucasian. Overall, 16% of patients at each hospital experienced rupture. Although the number of patients younger than 6 years and 65 years or older was small, rupture occurred more commonly in these patients (60% and 58%, respectively, versus 13% in patients 6 to 64 years old; p < 0.0001).
Discussion
Time between symptom onset and treatment, a potentially modifiable factor, is associated with risk of ruptured appendicitis. For the first 36hours after symptom onset, we found a 0% to 2% risk of rupture within each 12-hour period. For patients with longer periods of untreated symptoms, that risk rose and remained steady at around 5% for each ensuing 12-hour period with untreated symptoms. The majority of our patients (57%) did not present to care until they had symptoms for at least 24hours,
Acknowledgment
We thank all the physicians who kindly opened their offices to us; and to Eduard Aulov and Neysha Fletcher, our data collectors, whose tireless efforts and good cheer were unrelenting; and to Dr Mark Chassin for his constructive critical comments throughout the process.
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Competing Interests Declared: None.
Supported by Agency for Healthcare Research and Quality R-01 HS09698.