Hong Kong Med J 2000;6:254-9 | Number 3, September 2000
Delays by patients, emergency physicians, and surgeons in the management of acute appendicitis: retrospective study
CH Chung, CP Ng, KK Lai
Accident and Emergency Department, North District Hospital, Sheung Shui, New Territories, Hong Kong
OBJECTIVES. To compare the contributions of patients, emergency physicians, and surgeons in the delay of diagnosis and treatment of appendicitis, and the effects of delay on disease stage and complication rate.
DESIGN. Retrospective study.
SETTING. Accident and emergency department of a district public hospital, Hong Kong.
PATIENTS. All patients undergoing emergency appendectomy between August 1998 to September 1999.
MAIN OUTCOME MEASURES. Patient delay in presentation, emergency physician delay in hospital admission, and surgeon delay in performing the operation; operative findings; and postoperative complications.
RESULTS. Of 158 patients undergoing emergency operation, 14 had no pathological diagnosis and four had a diagnosis other than that of acute appendicitis. Of the 140 pathologically confirmed cases of appendicitis, the mean emergency patient delay was greater in advanced appendicitis than it was in simple appendicitis (42.0 hours versus 24.9 hours; P
CONCLUSION. There should be a higher index of suspicion, better surgical training, and better senior supervision at accident and emergency departments, to avoid preventable morbidity and mortality in acute appendicitis.
Key words: Acute disease; Appendectomy; Appendicitis/surgery; Appendicitis/diagnosis; Emergency medical services; Time factors
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