[Delayed appendectomy because of diagnostic malpractice: Experiences of the Arbitration Board of the North German
Heinrich Vinz1, Markward von Bülow1, Johann Neu1
1Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hannover, Deutschland.
Abstract:
From 2000 to 2012, 447 panel proceedings concerning acute appendicitis were evaluated. 271 cases (57 %) were related to alleged diagnostic malpractice. This was confirmed in 176 cases (67 %). The following medical specialities were involved (m = quote of malpractice): general surgery 33 %, m = 51 %; paediatric surgery 3 %, m = 44 %; general practitioner and prehospital emergency services 24 %, m = 62 %; internal medicine 19 %, m = 70 %; paediatrics 13 %, m = 57 %; gynaecology 3 %, m = 91 %; urology 2 %, m = 17 %. The most frequent misdiagnosis was gastroenteritis (43 % in adults, 69 % in children), obviously based on the concomitant symptom of diarrhoea. Surgery revealed all stages of advanced appendicitis up to peritoneal sepsis, organic failure and death (n = 5). The evaluation of the files and the experts' reports of the 176 cases of diagnostic malpractice allowed to define the following basic failures, which led to unjustified delay of operation: careless history-taking, no or incomplete physical examination, no follow-up investigations, incorrect interpretation of the patient's complaints and clinical findings, no or incomplete documentation. Conducting a thorough investigation is essential to avoiding diagnostic malpractice. Internal analysis of failures or near failures may contribute to reducing the number of future cases of malpractice.
Insights
Diagnostic malpractice in acute appendicitis cases is common, particularly among general practitioners and internists. Thorough investigations are crucial to prevent delayed diagnosis and improve patient outcomes.
Area of Science:
- Medical Malpractice
- Surgical Outcomes
- Diagnostic Errors
Background:
- Acute appendicitis is a common surgical emergency.
- Diagnostic errors can lead to delayed treatment and severe complications.
- Panel proceedings provide insights into malpractice claims.
Purpose of the Study:
- To analyze diagnostic malpractice cases in acute appendicitis.
- To identify specialties with high malpractice rates.
- To determine common diagnostic failures and misdiagnoses.
Main Methods:
- Evaluation of 447 panel proceedings from 2000-2012 concerning acute appendicitis.
- Analysis of 271 cases (57%) related to alleged diagnostic malpractice.
- Review of 176 confirmed malpractice cases (67% of allegations).
Main Results:
- 57% of cases involved alleged diagnostic malpractice, confirmed in 67% of these.
- Highest malpractice rates in gynecology (91%), internal medicine (70%), and general practitioners/emergency services (62%).
- Gastroenteritis was the most frequent misdiagnosis (43% adults, 69% children).
- Basic failures included poor history-taking, incomplete examination, and inadequate documentation.
- Advanced appendicitis, sepsis, and death occurred in 5 cases due to delayed operations.
Conclusions:
- Diagnostic errors in acute appendicitis are frequent and linked to specific medical specialties.
- Common failures involve inadequate patient assessment and diagnostic processes.
- Thorough investigations and internal analysis of errors are essential to reduce malpractice and improve patient care.
