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Robert Blanchard
Robert Blanchard
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Delays in Diagnosis

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I have just seen the results of a new study which attempts to quantify the risk of an appendix rupture relative to the time since the onset of symptoms. Not surprisingly, the longer you have been having symptoms, the greater your risk that the appendix is about to rupture. You don’t hear of many people suffering with a ruptured appendix anymore and this is no doubt due to the abilitiy of doctors to notice the tell tale signs of appendicitis. Other conditions also become more dangerous if not timely diagnosed, but the symptoms may not be so eay to decipher, this is where getting to a good doctor makes all the difference. I expect we will continue to see medical malpractice cases arising from physicians who do not timely diagnose conditions such as cancer, stroke and medication reactions. For a summary of the study….

The aim of this report was to study the timing between the onset of symptoms of appendicitis and the risk for rupture. The investigators studied the records of 219 patients from a total of 731 with documented appendicitis over a 2-year period in 2 metropolitan hospitals. At the time of surgery, 16% (n = 36) of the patients had sustained appendiceal rupture. The frequency of rupture was low in the first 36 hours after the onset of symptoms (< 2%), but increased to 5% in each of the ensuing 12-hour periods. In a multivariate analysis, total time since the beginning of the attack was the strongest risk factor (relative risk, 6.6). Other significant factors were age ≥ 65 (relative risk, 4.2), fever, and tachycardia.

This report quantifies the relationship between the duration of symptoms and risk for appendiceal rupture with well-known complications. Important factors that were associated with delay in diagnosis included the absence of right lower quadrant tenderness (19% of patients) and performance of a computed tomographic (CT) scan (18% of patients). The study results emphasize the benefit to the patient of making a diagnosis within a “golden” period of 36 hours.