Prehospital delay and its associated psychosocial factors in patients presenting with acute appendicitis in a southwestern city in China: a single-centre prospective observational study

Abstract

ObjectivePrehospital delay is common among patients with acute appendicitis. The aim of this study was to measure the association of a wide range of psychosocial factors with the prehospital delay among adult patients with acute appendicitis in a southwestern city in China.MethodsSociodemographic, clinical, cognitive and psychosocial factors were collected from 421 adult patients with acute appendicitis from November 2016 to December 2017. In addition, factors associated with prehospital delay were determined by binary logistic regression, after adjusting for selected potentially confounding factors.ResultsOnly 179 (42.5%) of the 421 patients were transferred to the hospital within 24 hours; the mean prehospital delay was 27.68 hours with a median of 26 hours, while the mean in-hospital delay was 5.16 hours with a median of 5 hours. In the logistic regression analyses, eight variables or subvariables were found to be associated with prehospital delay >24 hours.ConclusionDelayed presentation for acute appendicitis was associated with older age, living alone, a lack of knowledge of the disease, low social support, an unstable introvert personality trait and negative coping style, intensity of the pain and the symptoms occurring on a workday. A better understanding of the association between psychosocial factors and prehospital delay can help identify patients with acute appendicitis at risk of prehospital delay and lead to the establishment of an effective campaign to promote hospital visits when the symptoms are noticed.

Prehospital barriers for rural New Zealand parents in paediatric appendicitis: a qualitative analysis

“…This is the first qualitative investigation of prehospital patient behaviour in paediatric appendicitis and builds upon the knowledge gained by several projects investigating delay using patient surveys 8,17,28 . These methods simplified patient experience into quantitative data points created by a pre‐determined set of questions.…”

The Stanford Integrated Psychosocial Assessment for Transplant Is Associated With Outcomes Before and After Liver Transplantation

“…This is consistent with research in other disease processes that have shown that lack of social support and low financial resources can cause delays in seeking care. (16,17) Patients who are socially disadvantaged with lower social support were less likely to undergo waitlisting and may require enhanced transplant navigation and support. Finally, the higher prevalence of Black/ African American patients among patients with elevated SIPAT scores may reflect higher rates of socioeconomic deprivation/chronic stress that culminates in higher psychosocial risk.…”

Prehospital Delay and Its Associated Factors in Sudanese Patients Presenting With Acute Appendicitis at a Teaching Hospital

“…Many research findings have found a correlation between the time interval and the risk of appendicitis perforation; a long wait before operation results in complicated appendicitis and, as a result, high postoperative morbidity [4][5][6][7]. Prehospital delay may have played a more significant role in the progression of appendicitis and future postoperative complications [3,5]. According to Li et al, delayed prehospital presentation for acute appendicitis was associated with older age, residing alone, lack of knowledge about the disease, low social support, negative characteristics of mental well-being such as introvert personality and poor coping style, low severity of the pain, and symptoms occurring during work hours [3].…”

“…During admissions, acute appendicitis is misdiagnosed in 3.8%-15% of all children cases and 5.95%-23.5% of all cases [ 2 ]. Its postoperative complication and morbidity rates remain high, about 29% and 18%, respectively [ 3 ]. Prehospital delay of acute appendicitis is defined as the time interval from when a patient with a history of acute appendicitis comes after at least 48 hours of symptom onset [ 2 ].…”

“…Prehospital delay may have played a more significant role in the progression of appendicitis and future postoperative complications [ 3 , 5 ]. According to Li et al, delayed prehospital presentation for acute appendicitis was associated with older age, residing alone, lack of knowledge about the disease, low social support, negative characteristics of mental well-being such as introvert personality and poor coping style, low severity of the pain, and symptoms occurring during work hours [ 3 ]. This study investigated the prevalence of late prehospital presentation of acute appendicitis, clinical features, and outcomes in Sudanese patients.…”