A Clinical Study of Acute Appendicitis in Schizophrenia Patients Presenting at an Emergency Center

ABSTRACT

PURPOSE: To investigate the clinical characteristics and Alvarado scores of schizophrenia with patients acute appendicitis presenting at the emergency department. METHODS: We retrospectively reviewed medical records and identified schizophrenia patients who were diagnosed with acute appendicitis between January 2000 to December 2009 and who presented at the emergency department in 6 University hospitals. Comparisons were made with non-schizophrenic patients with acute appendicitis. Data collected included the patient's age, sex, clinical features, time interval between onset of symptoms and visiting the hospital, Alvarado score, disease complications, and diagnostic imaging modality. RESULTS: We identified 27 schizophrenia patients with acute appendicitis. Mean age was 34.5+/-8.3; 51.9% were women. The median time from onset of symptoms to visiting the emergency department was 3.8+/-1.4 days in the schizophrenic group and 2.3+/-2.1 in the normal control group. The mean Alvarado scores were 5.4+/-1.5 for the schizophrenic group and 6.5+/-2.1 for controls. Perforation of the appendix and formation of abscesses was higher in schizophrenic patients with appendicitis. CONCLUSION: These findings suggest that acute appendicitis is diagnosed late and with difficulty in schizophrenic patients and these patients may be the most vulnerable to failure to obtain timely surgical care. Early and careful access is recommended in suspected cases of appendicitis in schizophrenia patients.