Development Guideline of Acute Appendicitis Patients for Prevention Ruptured Appendicitis Phayakkhaphum Phisai Hospital Mahasarakham Province

Abstract

The purpose of this research and development was to development guideline of acute appendicitis patients for prevention ruptured appendicitis phayakkhaphum phisai hospital mahasarakham province. Study period from July 2021 - September 2022. Cycle I : Study of problem situations using quantitative research to identify factors associated with appendicitis rupture. Cycle II : Develop a guideline for the care of patients acute appendicitis to prevention rupture appendicitis with personnel in relevant departments, collecting data and evaluating. Research tools include: Assessment Alvarado Score, In-depth interview, Group converse, Risk Incident report Form, HosXP program analyzed quantitative data with descriptive statistics number percent, Inferential statistics, chi-square, t-test, multiple logistic regression and Qualitative data were analyzed using content analysis.

Results: Cycle I The risk factor associated with rupture appendicitis were the time from abdominal pain to hospital arrival that took ≥ 24 hours. There was a higher risk of appendicitis rupture than pre-hospital patients for 24 hours 1 time (ORadj = 1.13, 95%CI 0.13-0.65), The detection of rebound tenderness in the right lower abdomen which has 3 times the risk of appendicitis rupture (ORadj = 3.03, 95%CI 1.17-2.29), Leukocytosis (ORadj = 2.32, 95%CI 0.15-0.62) and quantity PMN white blood cell count (ORadj = 1.39, 95%CI 1.33-5.41), with a statistical significance level of 0.05. However, patients with appendicitis rupture and non ruptured appendicitis. Tenderness will be detected in the RLQ in everyone. Cycle II Guidelines for the care of patients with acute appendicitis have been developed to prevent rupture appendix. Even with a low Alvarado Score, if any condition is detected, namely Rebound Tenderness, Leukocytosis(>10000m3), high PMN, the doctor will consider surgery immediately. Assessment of patient care outcomes found that From taking care of 56 appendicitis patients, 6 had Ruptured appendix, accounting for 10.71% and no complications. which was 23.3% lower than before the development of Ruptured acute appendicitis.