Bickell et al identified risk factors in a patient with acute appendicitis that are associated with appendiceal rupture and delayed surgery. The authors are from Mount Sinai School of Medicine in New York.
Parameters associated with appendiceal rupture:
(1) number of hours from onset of symptoms to surgery
(2) age in years
(3) temperature in °C
(4) heart rate in beats per minute
(5) gender
|
Parameter |
Finding |
Odds Ratio |
Points |
|
number of hours |
< 36 hours |
6.6 |
4 |
|
|
>= 36 hours |
1 |
0 |
|
age in years |
< 65 years of age |
1 |
0 |
|
|
>= 65 years of age |
4.2 |
3 |
|
temperature |
< 38.9°C |
1 |
0 |
|
|
>= 38.9°C |
3.6 |
2 |
|
heart rate |
< 100 beats per minute |
1 |
0 |
|
|
>= 100 beats per minute |
3.4 |
2 |
|
gender |
male |
1.5 |
1 |
|
|
female |
1 |
0 |
where:
• The point system is not part of the original article. The point assignment was based on dividing the odds ratio by 1.5. The maximum score would be 12.
Risk factors for delayed surgery:
(1) absence of right lower tenderness
(2) not the classic presentation
(3) diagnosis uncertain
(4) first physician examination outside of hospital
(5) CT or ultrasound performed (probably reflecting uncertainty in diagnosis)
The main conclusion is that a delay in surgery beyond 36 hours after onset of symptoms was associated with an increasing risk for rupture.
Specialty: Gastroenterology, Pedatrics, Surgery, general
