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Clinical features of misdiagnosed appendicitis in children
S G Rothrock1, G Skeoch, J J Rush
1Department of Emergency Medicine, Loma Linda University Medical Center, California 92350.
Insights
Misdiagnosed appendicitis in children often presents with vomiting before pain, upper respiratory symptoms, and fewer classic signs like right lower quadrant tenderness. These differences highlight the need for careful evaluation in pediatric appendicitis cases.
Area of Science:
- Pediatric Surgery
- Emergency Medicine
- Diagnostic Accuracy
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate and timely diagnosis is crucial to prevent complications.
- Misdiagnosis can lead to delayed treatment and increased morbidity.
Purpose of the Study:
- To compare the clinical presentation of children with appendicitis who were initially misdiagnosed versus those correctly diagnosed.
- To identify specific features associated with misdiagnosis in pediatric appendicitis.
Main Methods:
- Retrospective review of medical records for children under 13 diagnosed with appendicitis.
- Comparison of clinical, physical examination, laboratory, and pathological findings between misdiagnosed and correctly diagnosed groups.
- Statistical analysis using chi-squared and Student's t-tests.
Main Results:
- Of 181 cases, 50 were initially misdiagnosed.
- Misdiagnosed children were younger and more likely to present with vomiting preceding pain, constipation, diarrhea, dysuria, and URI symptoms.
- Misdiagnosed cases showed less right lower quadrant tenderness, fewer documented bowel sounds, absent peritoneal signs, and incomplete rectal exams.
Conclusions:
- Clinical features distinguishing misdiagnosed appendicitis in children from correctly diagnosed cases were identified.
- Younger age, atypical symptom onset (vomiting before pain), and absence of classic physical findings are associated with misdiagnosis.
- Awareness of these differing features can improve diagnostic accuracy in pediatric appendicitis.
Study Objective:
To compare clinical features of children with misdiagnosed appendicitis with those of children with appendicitis initially diagnosed correctly.
Design:
Retrospective review of hospital, emergency department, and clinic records.
Setting:
University medical center with annual ED census of 40,000 patients.
Participants:
Children less than 13 years old admitted between May 1, 1979, and April 30, 1989, with a discharge diagnosis of appendicitis.
Measurements:
Records were reviewed for historical, physical examination, laboratory, and pathologic features for all patients on their initial presentation to a physician and on final presentation during which the correct diagnosis was made. Using chi 2 analysis and Student's test, clinical features of misdiagnosed patients and patients diagnosed correctly were compared.
Results:
One hundred eighty-one cases were identified with 50 initially misdiagnosed. On initial presentation, misdiagnosed patients were younger and more likely to have vomiting before pain onset, constipation, diarrhea, dysuria, and signs and symptoms of upper respiratory infections. Misdiagnosed cases were less likely to have right lower quadrant tenderness and documentation of bowel sounds, peritoneal signs, and rectal examinations. On final presentation, misdiagnosed patients were more likely to have pain duration of more than two days, temperature of more than 38.3 C, and to appear lethargic and irritable (P less than .05 for all measurements).
Conclusion:
Clinical features of children with misdiagnosed appendicitis differ from those of children with appendicitis initially diagnosed correctly.