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Risk Factors for Missed Appendicitis Diagnosis Identified

6 percent of adults and 4.4 percent of children misdiagnosed during initial emergency department visit

THURSDAY, April 2, 2020 (HealthDay News) — Certain patient and presentation factors increase the likelihood of a missed appendicitis diagnosis in the emergency department, according to a study published online March 9 in JAMA Network Open.

Prashant Mahajan, M.D., from the University of Michigan in Ann Arbor, and colleagues used commercially insured claims data to identify patients who presented to the emergency department with undifferentiated symptoms associated with appendicitis (abdominal pain, constipation, nausea and/or vomiting, fever, and diarrhea) between 2010 and 2017. The analysis included 123,711 patients (81.9 percent adults and 18.1 percent children) who had a previous emergency department visit within 30 days of an appendicitis diagnosis.

The researchers found that the frequency of potentially missed appendicitis was 6 percent among adults and 4.4 percent among children. A missed diagnosis was less likely for patients presenting with isolated abdominal pain (adults: adjusted odds ratio [aOR], 0.65; 95 percent confidence interval [CI], 0.62 to 0.69; P < 0.001; children: aOR, 0.79; 95 percent CI, 0.69 to 0.90; P < 0.001) or with abdominal pain and nausea and/or vomiting (adults: aOR, 0.90; 95 percent CI, 0.84 to 0.97; P = 0.003; children: aOR, 0.84; 95 percent CI, 0.71 to 0.98; P = 0.03). A missed diagnosis was more likely among patients with abdominal pain and constipation (adults: aOR, 1.51; 95 percent CI, 1.31 to 1.75; P < 0.001; children: aOR, 2.43; 95 percent CI, 1.86 to 3.17; P < 0.001). Missed appendicitis was less likely among adult patients who received computed tomography scans at the initial emergency department visit (abdominal pain: aOR, 0.58; 95 percent CI, 0.52 to 0.65; nausea and/or vomiting: aOR, 0.63; 95 percent CI, 0.52 to 0.75; fever: aOR, 0.41; 95 percent CI, 0.29 to 0.58; diarrhea: aOR, 0.83; 95 percent CI, 0.58 to 1.20; and constipation: aOR, 0.60; 95 percent CI, 0.39 to 0.94).

“Regardless of age, a missed diagnosis of appendicitis was more likely to occur in women, patients with comorbidities, and patients who experienced abdominal pain accompanied by constipation,” the authors write.

One author disclosed financial ties to Lucent Surgical Support Systems.

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