title: Impact of time in the development of acute appendicitis.
abstract: BACKGROUND
  The aim of this study was to elucidate the natural history of appendicitis.
  
  
  METHODS
  Data was collected prospectively from consecutive patients admitted to hospital for acute abdominal pain. The degree of appendiceal inflammation in relation to preoperative duration of pain was analysed.
  
  
  RESULTS
  The study comprised 253 patients operated on for acute appendicitis that could recall the onset of abdominal pain. There was a longer duration of pre-hospital pain in patients, irrespective of age, with perforated appendicitis compared to patients with phlegmonous or gangrenous appendicitis (p < 0.001). In the multivariate analysis, patient age and preoperative duration of pain were independent risk factors for perforation.
  
  
  CONCLUSIONS
  Patient delay in presentation is the predominant factor determining the incidence of complicated appendicitis, and this delay is not influenced by age or gender.
authors.affiliation: Department of Surgery at Sahlgrenska University Hospital, Gothenburg, Sweden. lars-erik.hansson@vgregion.se
authors.forename: L-E
authors.initials: LE
authors.lastname: Hansson
authors.forename: H
authors.initials: H
authors.lastname: Laurell
authors.forename: U
authors.initials: U
authors.lastname: Gunnarsson
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome