Prehospital delay and its associated psychosocial factors in patients presenting with acute appendicitis in a southwestern city in China: a single-centre prospective observational study

OBJECTIVE: Prehospital delay is common among patients with acute appendicitis. The aim of this study was to measure the association of a wide range of psychosocial factors with the prehospital delay among adult patients with acute appendicitis in a southwestern city in China. METHODS: Sociodemographic, clinical, cognitive and psychosocial factors were collected from 421 adult patients with acute appendicitis from November 2016 to December 2017. In addition, factors associated with prehospital delay were determined by binary logistic regression, after adjusting for selected potentially confounding factors. RESULTS: Only 179 (42.5%) of the 421 patients were transferred to the hospital within 24 hours; the mean prehospital delay was 27.68 hours with a median of 26 hours, while the mean in-hospital delay was 5.16 hours with a median of 5 hours. In the logistic regression analyses, eight variables or subvariables were found to be associated with prehospital delay >24 hours. CONCLUSION: Delayed presentation for acute appendicitis was associated with older age, living alone, a lack of knowledge of the disease, low social support, an unstable introvert personality trait and negative coping style, intensity of the pain and the symptoms occurring on a workday. A better understanding of the association between psychosocial factors and prehospital delay can help identify patients with acute appendicitis at risk of prehospital delay and lead to the establishment of an effective campaign to promote hospital visits when the symptoms are noticed.