Misses and Near Misses in Paediatric Appendicitis: An Eight-Year, Single-Centre Retrospective Review

Diagnostic error can result in the appendectomy of a normal appendix, commonly known as negative appendectomy (NA). Missed appendicitis (MA) is related to a poor outcome. The aim of this study was to determine whether there are factors in presentation associated with NA or MA.

This is a single-centre, retrospective chart review of histology-confirmed appendicitis over an eight-year period. We defined MA as appendicitis diagnosed within the week of a paediatric emergency department discharge for a similar presentation. Negative appendectomy was defined as a histologic examination of the appendix that lacked signs of inflammation.

A total of 845 children had appendicitis on pathologic examination. NA included 69 children, and MA 29 children. Inflammatory markers were lower for children with NA than for children with appendicitis, and children with NA were less likely to undergo CT. Almost half of the children with MA were discharged without laboratory evaluation, and almost three quarters were discharged without imaging evaluation. Half of the children with MA returned with complicated appendicitis.

Increased rates of laboratory and/or imaging evaluations in patients with abdominal pain or non-classic gastroenteritis, along with observation or early follow-up, may decrease MA. More frequent use of ultrasound and MRI may keep the NA rate to a minimum.