Influence of delays on perforation risk in adults with acute appendicitis.

Hdl Handle:
http://hdl.handle.net/10147/208951
Title:
Influence of delays on perforation risk in adults with acute appendicitis.
Authors:
Kearney, D; Cahill, R A; O'Brien, E; Kirwan, W O; Redmond, H P
Affiliation:
Department of Surgery, Cork University Hospital, Cork, Ireland.
Citation:
Dis Colon Rectum. 2008 Dec;51(12):1823-7. Epub 2008 Jun 27.
Journal:
Diseases of the colon and rectum
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/208951
DOI:
10.1007/s10350-008-9373-6
PubMed ID:
18584252
Abstract:
PURPOSE: This study analyzed whether prehospital or in-hospital delay was the more significant influence on perforation rates for acute appendicitis and whether any clinical feature designated patients requiring higher surgical priority. METHODS: A retrospective analysis was conducted over one year at a tertiary referral hospital without a dedicated emergency surgical theater. Admission notes, theater logbook, and the Hospital Inpatient Enquiry system were reviewed to identify the characteristics and clinical course of patients aged greater than 16 years who were operated upon for histologically confirmed acute appendicitis. RESULTS: One hundred and fifteen patients were studied. The overall perforation rate was 17 percent. The mean duration of symptoms prior to hospital presentation was 38.1 hours with the mean in-hospital waiting time prior to operation being 23.4 hours. Although body temperature on presentation was significantly greater in patients found to have perforated appendicitis (P < 0.05), only patient heart rate at presentation and overall duration of symptoms, but not in-hospital waiting time, independently predicted perforation by stepwise linear regression modeling. CONCLUSION: In-hospital delay was not an independent predictor of perforation in adults with acute appendicitis although delays may contribute if patients are left to wait unduly. Tachycardia at presentation may be a quantifiable feature of those more likely to have perforation and who should be given higher surgical priority.
Language:
eng
MeSH:
Adult; Appendectomy; Appendicitis/*diagnosis/etiology/*surgery; Cohort Studies; Emergency Service, Hospital; Female; Humans; Length of Stay; Linear Models; Male; Middle Aged; Retrospective Studies; Risk Factors; Time Factors; Triage
ISSN:
1530-0358 (Electronic); 0012-3706 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorKearney, Den_GB
dc.contributor.authorCahill, R Aen_GB
dc.contributor.authorO'Brien, Een_GB
dc.contributor.authorKirwan, W Oen_GB
dc.contributor.authorRedmond, H Pen_GB
dc.date.accessioned2012-02-03T15:08:18Z-
dc.date.available2012-02-03T15:08:18Z-
dc.date.issued2012-02-03T15:08:18Z-
dc.identifier.citationDis Colon Rectum. 2008 Dec;51(12):1823-7. Epub 2008 Jun 27.en_GB
dc.identifier.issn1530-0358 (Electronic)en_GB
dc.identifier.issn0012-3706 (Linking)en_GB
dc.identifier.pmid18584252en_GB
dc.identifier.doi10.1007/s10350-008-9373-6en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208951-
dc.description.abstractPURPOSE: This study analyzed whether prehospital or in-hospital delay was the more significant influence on perforation rates for acute appendicitis and whether any clinical feature designated patients requiring higher surgical priority. METHODS: A retrospective analysis was conducted over one year at a tertiary referral hospital without a dedicated emergency surgical theater. Admission notes, theater logbook, and the Hospital Inpatient Enquiry system were reviewed to identify the characteristics and clinical course of patients aged greater than 16 years who were operated upon for histologically confirmed acute appendicitis. RESULTS: One hundred and fifteen patients were studied. The overall perforation rate was 17 percent. The mean duration of symptoms prior to hospital presentation was 38.1 hours with the mean in-hospital waiting time prior to operation being 23.4 hours. Although body temperature on presentation was significantly greater in patients found to have perforated appendicitis (P < 0.05), only patient heart rate at presentation and overall duration of symptoms, but not in-hospital waiting time, independently predicted perforation by stepwise linear regression modeling. CONCLUSION: In-hospital delay was not an independent predictor of perforation in adults with acute appendicitis although delays may contribute if patients are left to wait unduly. Tachycardia at presentation may be a quantifiable feature of those more likely to have perforation and who should be given higher surgical priority.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAppendectomyen_GB
dc.subject.meshAppendicitis/*diagnosis/etiology/*surgeryen_GB
dc.subject.meshCohort Studiesen_GB
dc.subject.meshEmergency Service, Hospitalen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLength of Stayen_GB
dc.subject.meshLinear Modelsen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshRisk Factorsen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTriageen_GB
dc.titleInfluence of delays on perforation risk in adults with acute appendicitis.en_GB
dc.contributor.departmentDepartment of Surgery, Cork University Hospital, Cork, Ireland.en_GB
dc.identifier.journalDiseases of the colon and rectumen_GB
dc.description.provinceMunster-

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