Time From Emergency Department Evaluation to Operation and Appendiceal Perforation

Area of Science:

• Pediatric Surgery
• Emergency Medicine
• Clinical Outcomes Research

Background:

• Appendicitis risk of perforation increases with symptom duration.
• Time from symptom onset to intervention is critical for appendicitis outcomes.

Purpose of the Study:

• To determine if time from emergency department (ED) physician evaluation to operative intervention is independently associated with appendiceal perforation (AP) in children.
• To analyze the impact of ED-to-operation duration on AP odds in pediatric appendicitis patients.

Main Methods:

• Secondary analysis of a prospective, multicenter study of children (3-18 years) with abdominal pain.
• Used multivariable logistic regression to assess ED evaluation to operation time and AP odds, adjusting for risk factors.
• Analyzed a subpopulation without initial computed tomography (CT) evidence of perforation.

Main Results:

• 25.9% of 955 children with appendicitis had AP.
• Median ED evaluation to operation time was 7.2 hours.
• Time delays (≤24 hours) from ED evaluation to operation did not significantly increase AP odds (OR=1.0; 95% CI, 0.96-1.05), even in those without initial CT findings.

Conclusions:

• Short time delays from ED evaluation to operation are not independently associated with increased appendiceal perforation in children.
• While symptom duration matters, ED-to-surgery timing does not independently elevate perforation risk.