The Critical Window for Appendicitis Diagnosis: A Time-Based Analysis of Rupture Risk

Abstract

Background: Risk of appendix rupture varies over time. It aims to identify factors contributing to treatment delays, potentially heightening rupture risk. Findings could help surgeons intervene more quickly, lowering rupture chances and improving outcomes. Insights could contribute to effective treatment guidelines, particularly benefiting regions with limited healthcare access.

Objectives: To understand how appendix rupture risk changes over time and to identify factors associated with rupture and treatment delays, facilitating prompt intervention and better outcomes.

Materials and Methods: A retrospective analysis of 800 acute appendicitis cases at Rajavithi Hospital (October 2019 - September 2022) assessed symptom onset time and initial clinical signs. Patients diagnosed and treated for acute appendicitis were included; prior cases or incomplete records were excluded. Symptom onset was patient-reported, and diagnoses were based on initial assessments. Rupture was confirmed intraoperatively. Statistical analysis used a significance level of p < 0.05.

Results: Participants' mean age was 35.78 ± 14.33 years. Average time from symptom onset to hospital presentation was 23.90 ± 23.87 hours, and door-to-surgery time was 12.79 ± 6.99 hours. Univariate analysis showed significant associations between rupture and older age (p = 0.002), higher temperature (p = 0.002), increased heart rate (p < 0.001), higher ASA class (p < 0.001), and elevated WBC count (p < 0.001). No significant association was found with gender, symptom onset-to-hospital time, or intra-hospital timeframes. Multivariate analysis confirmed older age (p = 0.011), higher temperature (p = 0.019), elevated pulse rate (p < 0.001), higher ASA class (p = 0.038), WBC ≥ 10,000 (p = 0.002), increased door-to-ATB time (p = 0.018), and longer surgical consultation time (p = 0.039) as rupture predictors.

Conclusion: Older age, elevated temperature, heart rate, WBC count, higher ASA classification, and delays (door-to-ATB time, surgical consultation time) are significant factors influencing appendicitis rupture. Addressing these could improve outcomes.