Missed Opportunity for Initial Diagnosis in Children With Complex Appendicitis.

Area of Science:

• Pediatric Surgery
• Emergency Medicine
• Diagnostic Accuracy

Background:

• Delayed diagnosis of acute appendicitis in children can lead to complex appendicitis and perforation.
• Missed opportunity for initial diagnosis (MOID) is a key factor in delayed diagnosis, often occurring outside specialized pediatric centers.

Purpose of the Study:

• To determine the rate of MOID in children with complex appendicitis across all initial presenting facilities.
• To identify risk factors associated with MOID in pediatric complex appendicitis.

Main Methods:

• Retrospective review of children (≤18 years) with complex appendicitis undergoing appendectomy (2018-2022).
• MOID defined as evaluation for related symptoms without appendicitis diagnosis within 7 days prior to surgery.
• Logistic regression and UpSet plots used to analyze risk factors.

Main Results:

• 16.4% of 856 children experienced MOID, predominantly from non-tertiary facilities (urgent care, local EDs, primary care).
• MOID was linked to younger age and non-English/Spanish primary language; uninsured patients had lower MOID.
• MOID correlated with increased complications, longer hospital stays, and higher readmission rates.

Conclusions:

• MOID is prevalent in non-tertiary settings for pediatric complex appendicitis.
• Younger children and non-English speakers are at higher risk for MOID.
• Improved diagnostic strategies, including interpreter services and algorithmic evaluation, are needed in non-tertiary facilities.