Analysis of Influencing and Predictive Factors for Perforated Appendicitis in the Emergency Department
LI Zhengming
WANG Jiangfeng
Abstract：Objective To investigate the independent risk factors for perforation in patients with appendi-citis admitted through the emergency department and the efficacy of clinical prediction tools,in order to provide a basis for early identification of high-risk patients.Methods A retrospective analysis was conducted on 100 patients with appendicitis admitted to our emergency department from January 2023 to December 2024.Based on postoperative pathology,they were divided into two groups:a perforation group(n=44)and a non-perforation group(n=56).Data collected included demographic characteristics(gender,age),clinical manifestations(body tempera-ture,right lower quadrant tenderness,rebound tenderness,muscle guarding,pain characteristics,anorexia,nausea and vomiting,symptom duration),and laboratory parameters[White Blood Cell count(WBC),Neutrophil Percent-age(NEUT%),abnormal urinalysis,C-reactive Protein(CRP)].The Appendicitis Inflammatory Response(AIR)score,Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA)score,and Adult Appendicitis Score(AAS)were calculated.Binary multivariate logistic regression analysis was used to identify independent risk factors for perfo-ration,and the diagnostic value of predictive factors was assessed using Receiver Operating Characteristic(ROC)curves.Results Among the 100 patients with appendicitis,56 had non-perforated and 44 had perforated appen-dicitis.Significant differences were observed in body temperature,rebound tenderness,muscle guarding,symptom duration,WBC,NEUT%,abnormal urinaly-sis,CRP,AIR score,RIPASA score,and AAS score(P<0.05).No significant differences were found in gender,age,right lower quadrant tenderness,right lower quadrant pain,migratory pain to the right lower quadrant,anorexia,or nausea and vomiting(P>0.05).Multivariate logistic regression analysis showed that body temperature≥38℃(OR=3.902),rebound tenderness(OR=3.474),symptom duration(OR=1.067 per hour increase),NEUT%>85%(OR=1.093),CRP>50 mg/L(OR=1.044),and AAS score(OR=1.627)were independent predictors of perforation(P<0.05).ROC analysis confirmed that the combined model had the best predictive performance(AUC=0.920).Both the AAS score(AUC=0.890,cutoff value≥16)and CRP(AUC=0.891,cutoff value>50 mg/L)demonstrated sensitivity>84%and specificity>83%.Symptom duration>24 hours had the highest sensitivity(86.36%).Con-clusion Elevated body temperature,rebound tenderness,delayed symptom presentation,significantly elevated neutrophil percentage and CRP,and a high AAS score are independent predictors of perforation.A combined model based on these indicators can significantly improve the accuracy of identification in the emergency department.
Keywords：Perforated appendicitisInfluencing factorsPredictive factors
Publication Date：2025-09-28
Online Publishing Date：2026-01-27(First online date of this platform, not the publication date of the document)
Pages：5( 1105-1109 )