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Clinician factors associated with delayed diagnosis of appendicitis

Kenneth A Michelson1,2, Finn L E McGarghan1, Emma E Patterson1

  • 1Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.

Diagnosis (Berlin, Germany)
|December 9, 2022
PubMed

Insights

Clinicians ordering more blood tests reduced the risk of delayed appendicitis diagnosis in children. This suggests that a lower risk tolerance in clinical practice may improve diagnostic timeliness.

Area of Science:

  • Pediatric Emergency Medicine
  • Diagnostic Accuracy
  • Clinical Practice Patterns

Background:

  • Delayed diagnosis of appendicitis can lead to increased morbidity.
  • Understanding factors influencing diagnostic delays is crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate the relationship between clinician practice patterns and delayed appendicitis diagnosis in children.
  • To identify specific clinician characteristics associated with diagnostic delays.

Main Methods:

  • Retrospective chart review of children diagnosed with appendicitis across 13 emergency departments.
  • Logistic regression analysis was used to assess the association between clinician factors and delayed diagnosis.

Main Results:

  • 1.4% of 7,452 children experienced a delayed diagnosis of appendicitis.
  • Clinicians in the lowest quartile for ordering blood tests had a significantly higher odds of delayed diagnosis (OR 4.9).
  • No association was found between clinician imaging rates, specialty, sex, or experience and delayed diagnosis.

Conclusions:

  • Higher utilization of blood tests by clinicians was associated with a lower risk of delayed appendicitis diagnosis.
  • This finding may indicate that a lower risk tolerance in clinical decision-making benefits diagnostic timeliness.
Abstract

Keywords:
appendicitisemergency departmentemergency medicinerisk tolerance

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