Ayaz Ghulam Rasool, Maaz Obaid, Muhammad Azam Akhter, Lal Shehbaz, Shua Nasir, Zain Ali.
To determine the factors that affect the delay in diagnosis of acute appendicitis, affecting the morbidity and mortality of patients, at a tertiary care center in Karachi, Pakistan.
Pak J Surg Jan ;32(4):213-7.

Objective: The aim of our study is to determine the factors that affect the delay in diagnosis of acute appendicitis, in order to decrease the morbidity and mortality of this condition. Method: The type of study is a cross sectional study, conducted for a period of one year from May 2014 to May 2015 at a tertiary care center in Karachi, Pakistan. The total study population consisted of 150 patients, the inclusion criteria was all the patients who were above 16 years of age, and presented to the emergency department with delayed presentation (two or more than two days after initial attack) of acute appendicitis, and gave consent to take part in the study, the exclusion criteria was all the patients who were under 16 years of age, presented earlier than two days of signs and symptoms of acute appendicitis and those who refused to give consent. Characteristics of patients were noted in a predesigned proforma. Various characteristics of the patients were noted including age, gender, address, reason for delay, diagnosis made by the physician etc. Data was analyzed using SPSS version 23. Results: The study population consisted of 150 patients, having a mean age of 35± 12 years, of which 92 (61.33%) were males and 58 (38.66%) were females. 42 (28%) of the patients were misdiagnosed by the physicians in the emergency department on initial presentation and were referred as an outpatient case, while 50 (33.33%) of the patients were managed by non physicians on the initial attack of appendicitis, which included homeopaths, hakeems, spiritual healers, chiropractors, nurses, and patients who self medicate, and 32 (21.33%) of the patients stayed at home, and did not seek any medical attention in the initial two days of appendicitis. The most common reason for the delay was a lack of financial resources from the patient or the family which accounted for 43.33% of the cases. Conclusion: For the proper management of acute appendicitis it is imperative that an early diagnosis and surgical intervention be done, which significantly decreases the complications, morbidity and mortality of these patients. There is an emergent need to educate the public to seek adequate care in due time so as to avoid unnecessary complications.

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