Associated factors of ruptured appendicitis in acute appendicitis patients at the emergency department, Ramathibodi Hospital

Abstract

Introduction: Acute appendicitis is a common cause of acute abdominal pain in emergency department (ED). Majorcomplication is ruptured appendicitis which affect both physical complications and cost of treatment.The objective was to study factors associated with ruptured appendix in patients at the emergency room,Ramathibodi Hospital.

Method: A retrospective cross sectional study was conducted in patients who visited ED Ramathibodi Hospitalwith acute abdominal pain, older than 15 years old and underwent surgery due to diagnosis of acuteappendicitis from June 2005 to December 2007.

Result: Sixty cases were diagnosed as acute appendicitis and underwent appendectomy at Ramathibodi Hospital.There were 25 males (41.7%) and 35 females (58.3%). 29 cases (48.3%) had ruptured appendicitis. Sex,weight, heart rate, the presenting of nausea, vomiting, anorexia and fever, abdominal signs, white blood cellscount, band form polymorphonuclear (PMN) cells percentage, white blood cell in urine and the time from triageto operation did not associated with ruptured appendicitis. Time from onset of abdominal pain to triage(pre ED time) was longer in ruptured appendicitis group (64.83 and 23.29 hrs, p = 0.045). Higherpercentage of PMN in complete blood count (CBC) was significantly detected in ruptured appendicitis(84.14% and 78.58%, p = 0.006). Ruptured appendicitis patients had statistically significant longer lengthof hospital stay comparison with non ruptured group (6.85 days and 4.52 days, p = 0.007). There wasno death.

Discussion and Conclusion: Rupture appendicitis related to longer pre ED time period, higher percentage of PMN in CBC and also prolong hospital stay significantly.

Key words: Acute appendicitis, Ruptured appendicitis, Emergency room