Outcome of CPG for Acute Appendicitis in Thoen Hospital, Lampang Province, Thailand

Abstract

Acute appendicitis was the most common emergency surgical conditions; and had long been at the sixth rank in in-patient cases of Thoen hospital. Misdiagnosis and delayed in diagnosis was 13.46% and number of ruptured appendicitis rose up to 9.60% in the 2015 fiscal year. In a small community hospital with only one surgeon and one anaesthetic nurse, misdiagnosis resulting in ruptured appendicitis and complications could creat problems and decrease patients satisfaction. Even though the Alvarado scoring system was used, such problems could not be completety solved. Misdiagnosis and ruptured appendicitis were still at 2.95% and 10.00% respectively in the fiscal year 2016. The cause of the problems was due to the fact that there was no clinical practice guideline (CPG) used for this disease in the hospital. The objective of this study was to assess the efficacy of a CPG guideline for acute appendicitis diagnosis, compared to the use of Alvarado scoring system. Additional aim was to study satisfactory level among medical personel, patients with acute appendicitis and their relatives after implementation of the CPG. The study was conducted in two phases. In the phase I, a retrospective descriptive study was performed among patients diagnosed as acute appendicitis between June 2015- April 2017. The patients were categorized into two groups: (1) the group treated before the use of Alvarado score, and (2) the Alvarado score usedgroup. Efficacy of the diagnosis and the characteristics of the appendix (as seen by surgeon intra-operation) were compared between the two groups. Phase II study was conducted between May 2017-August 2017 assessing the effectiveness of the use of CPG together with the use of Alvarado score for acute appendicitis with regard to the diagnosis and the satisfaction of the surgeon, the patients and their relatives. Data were analyzed using ANOVA and paired t-test; p-values of less than 0.05 were considered statistically significant. The results showed that the were 246 patients with acute appendicitis during the study period: 104 for group 1, 104 for the group 2 and 38 for the CPG group. The accuracy for diagnosed of each group was 98.10%, 95.20% and 100.00%, respectively. Medical personel ’s satisfaction level for the CPG was at good level, with mean of 3.24, S.D. 0.55, Min 2, Max 4; whereas that of patients and relatives was at excellent level, with the means of 3.83, S.D. 0.29, Min 3.25, Max 4. This study shows that using (CPG) for acute appendicitis in Thoen Hospital, Lampang province, was effective and was able to increase satisfaction level among medical personnel, patients and relatives.