title: Risk factors associated with perforated appendicitis in elderly patients presenting with signs and symptoms of acute appendicitis.
abstract: BACKGROUND
  The aim of this study was to identify factors associated with rupture in elderly patients with acute appendicitis.
  
  
  METHODS
  The medical records of 601 consecutive patients >60 years of age with acute appendicitis between 1995 and 2005 were retrospectively reviewed. Historical, clinical and laboratory factors in patients with both intact and ruptured appendices were examined with univariate and multivariate analyses by logistic regressions.
  
  
  RESULTS
  Nine factors predicted appendiceal rupture age (odds ratio (OR) 1.05, confidence interval (CI) 1.02-1.07), male sex (OR 1.96, CI 1.35-2.06), preadmission duration of pain (OR 1.23, CI 1.11-1.36), interval of time from admission to surgery (OR 1.02, CI 1.01-1.04), fever >38 degrees C (OR 2.59, CI 1.78-3.77), left shift in leucocyte count >76% (OR 2.34, CI 1.27-4.32), anorexia (OR 2.03, CI 1.38-2.99) and a retrocaecally positioned appendix (OR 1.93, CI 1.15-3.24).
  
  
  CONCLUSIONS
  The incidence of appendiceal rupture, or complications secondary to appendiceal rupture, in elderly patients may be decreased if surgery is expedited when the temperature is >38 degrees C or there is a left shift in leucocyte count >76%, especially in men with anorexia.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Bor-Fuh
authors.initials: BF
authors.lastname: Sheu
authors.forename: Te-Fa
authors.initials: TF
authors.lastname: Chiu
authors.forename: Jih-Chang
authors.initials: JC
authors.lastname: Chen
authors.forename: Meng-Sheng
authors.initials: MS
authors.lastname: Tung
authors.forename: Meng-Wei
authors.initials: MW
authors.lastname: Chang
authors.forename: Yui-Rwei
authors.initials: YR
authors.lastname: Young
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000150:complications* / Q000209:etiology*; D005260:Female; D005334:Fever; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors