Missed appendicitis in a pediatric emergency department

Area of Science:

• Pediatric Surgery
• Emergency Medicine
• Diagnostic Accuracy

Background:

• Appendicitis is a leading cause of pediatric abdominal surgery.
• Delayed diagnosis of appendicitis in the emergency department (ED) contributes to professional liability.
• Identifying factors for missed appendicitis diagnoses is crucial for improving patient outcomes.

Purpose of the Study:

• To determine the incidence of delayed appendicitis diagnosis requiring multiple ED visits.
• To identify clinical characteristics differentiating patients with delayed appendicitis diagnosis.

Main Methods:

• Retrospective review of pediatric appendicitis cases diagnosed in the ED.
• Analysis of patient demographics, clinical presentations, and diagnostic timelines.
• Comparison of clinical features between patients diagnosed on first visit versus those requiring subsequent visits.

Main Results:

• Seven percent (6/87) of pediatric appendicitis patients required more than one ED visit for diagnosis.
• Patients with delayed diagnosis were more likely to have a normal appetite, diarrhea, and be afebrile.
• Delayed diagnosis was associated with a higher rate of appendiceal rupture (50% vs. 28%).

Conclusions:

• A significant minority of pediatric appendicitis cases are initially missed in the ED.
• Specific clinical features, such as lack of fever and presence of diarrhea, may indicate a need for closer observation in appendicitis evaluations.
• Timely diagnosis of appendicitis is critical to prevent complications like rupture.