Presurgical time and associated factors as predictors of acute perforated appendicitis: a prospective cohort study in a teaching pediatric hospital in Colombia

Abstract

Background We aim to determine the association between out and in-hospital factors with time, from the beginning of the symptoms to the surgery, in patients with acute appendicitis treated at Fundación Hospital Pediatrico La Misericordia (HOMI) in Colombia. Methods Eleven month prospective cohort study of pediatric patients at HOMI with acute appendicitis diagnosis taken to surgery. Data from the out-of-hospital phase was collected by surveying parents, and the data regarding the in-hospital phase was completed with medical records. We analyzed the association between the time from the beginning of the symptoms to the surgery, and out and in-hospital factors associated with this time using generalized linear models. Results Eight hundred three patients were included in the study. Total pre-surgical time was longer in perforated appendicitis (PA) group (2.65 days, standard deviation (SD) 1.88 vs. 2.04 days, SD 1.45) (p < 0.01). Factors associated with longer total and out-of-hospital presurgical times were age under 4 years old, lower socioeconomic status, father as a caregiver, self-medication, and underestimating disease severity. Conclusions Out-of-hospital timing determines the longer pre-surgical time in complicated appendicitis. Younger age and lower socioeconomic status affect time significantly. We suggest the implementation of strategies in order to lower prehospital time, rates, and costs of complicated appendicitis.

Appendicitis Hospitalization Care Costs Among Patients With Delayed Diagnosis of Appendicitis

“…This estimate includes perforated appendicitis, as well as any 30-day revisits to give a more realistic cost comparison because patients present with perforated appendicitis for many reasons other than delayed diagnosis. 29 , 30 , 31 Appendicitis is diagnosed for 292 297 patients annually in the US. 32 A 2.7% rate of delayed diagnosis will impact 7892 patients annually and, given the mean marginal cost difference is $2712.45, this leads to $21 406 655 of preventable cost from poor diagnostic quality every single year.…”

“…This estimate includes perforated appendicitis, as well as any 30-day revisits to give a more realistic cost comparison because patients present with perforated appendicitis for many reasons other than delayed diagnosis. [29][30][31] Appendicitis is diagnosed for 292 297 patients annually in the US. 32…”

“…This study sought to quantify the differences in appendicitis hospital care costs associated with delayed appendicitis diagnosis. This estimate includes perforated appendicitis, as well as any 30-day revisits to give a more realistic cost comparison because patients present with perforated appendicitis for many reasons other than delayed diagnosis . Appendicitis is diagnosed for 292 297 patients annually in the US .…”

Factores predictores de apendicitis perforada en población pediátrica en un Hospital de referencia en Bogotá D.C., Colombia

“…These findings are in line with the multivariate analysis of other studies where it has been established that this factor is one of the most frequently identified as a predictor of perforation. 21,22,24,[27][28][29] Concerning clinical variables, the only symptom associated with perforated appendicitis that remained significant in the multivariate analysis was the presence of emesis in the questioning on admission to the emergency department (OR=4.28, 95%CI: 1.63-11.21). Regarding clinical signs during physical examination, temperature >38.3ºC and tachycardia also had a positive association with perforation, which is partly in line with what has been reported in the literature, where fever has been associated with an increased risk of this outcome in the pediatric population, 4,24,27 but no association with tachycardia has been described.…”

Characteristics and Clinical Outcomes Associated with Appendix Location in Children with Acute Appendicitis

“…Acute appendicitis (AA) is the most common abdominal surgical pathology in the pediatric population [1,2]. The clinical manifestations and imaging findings may vary according to age, sex, underlying pathological conditions, and the development of complications, including perforation [3][4][5][6]. It has been suggested that the appendix location may affect the disease's overall behavior, although no studies confirm this.…”