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Misdiagnosed acute appendicitis in children in the emergency department
Yi-Jung Chang1, Hsun-Chin Chao, Man-Shan Kong
1Department of Pediatrics, Chang Gung Memorial Hospital at Taipei, Chang Gung University College of Medicine, Tauyuan, Taiwan.
Insights
Pediatric appendicitis is often misdiagnosed in emergency departments, especially when patients present with fewer symptoms, late at night, leading to higher perforation rates.
Area of Science:
- Pediatric Emergency Medicine
- Surgical Gastroenterology
Background:
- Appendicitis diagnosis in children presenting to the emergency department (ED) can be challenging.
- Identifying factors contributing to delayed diagnosis is crucial for improving patient outcomes.
Purpose of the Study:
- To determine clinical features differentiating children with appendicitis who required multiple ED visits from those diagnosed on their first visit.
Main Methods:
- Retrospective review of pediatric appendicitis cases diagnosed in the ED from January to December 2004.
- Comparison of clinical features between initially misdiagnosed patients and those correctly diagnosed on first presentation.
Main Results:
- 15% of pediatric appendicitis cases involved multiple ED visits.
- Misdiagnosed children often presented with shorter symptom duration, late at night, fewer physical findings, and less diagnostic workup.
- Initially misdiagnosed patients had a higher rate of appendiceal perforation.
Conclusions:
- Misdiagnosis of appendicitis in the pediatric ED is a significant issue.
- Factors such as brief ED stays, limited testing, reduced imaging, and subtle physical findings contribute to misdiagnosis, particularly for late-night presentations.
Background:
To identify clinical features that distinguish children with appendicitis who visited the emergency department twice or more from those diagnosed on the first visit to the emergency department.
Methods:
A retrospective review of all children with appendicitis diagnosed in the emergency department between January and December 2004 was conducted. Records were reviewed for all patients on their initial presentation to the emergency department. Clinical features were compared between those children who were misdiagnosed and those who were diagnosed correctly.
Results:
One hundred seventy-three cases were included (mean age, 10.4 years). Twenty-six (15%) were seen twice or more in the emergency department before appendicitis was diagnosed. Misdiagnosed patients had a relatively shorter duration of symptoms at their initial visit, and most presented late at night. Eighteen misdiagnosed patients (69.2%) initially visited the emergency department within 24 hours of onset of symptoms. Compared with patients diagnosed correctly on initial presentation, misdiagnosed patients had a significantly shorter hospital stay, fewer laboratory tests, and fewer physical findings of right lower quadrant tenderness, muscle guarding, rebound tenderness, fever, and migrating pain. Patients diagnosed late at night had a significantly shorter hospital stay and fewer abdominal ultrasound evaluations. On final presentation, initially misdiagnosed patients had a higher rate of appendiceal perforation than did correctly diagnosed patients.
Conclusion:
Misdiagnosed appendicitis is a problem in the emergency department. A shorter stay in the emergency department, fewer laboratory tests, less diagnostic imaging, and fewer physical findings may be responsible for misdiagnosed appendicitis late at night in the emergency department.
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