Abstract
Background Missed appendicitis is a frequent cause of professional liability for emergency department
(ED) physicians. Our objective was to assess and compare the presentations of patients
in whom the diagnosis of appendicitis was missed with those in whom it was correctly
diagnosed on their first ED visit and to identify the clinical features that characterized
the two groups.
Methods This study is a retrospective review of all ED children with proven appendicitis
between January 2010 and December 2013. Historical, clinical, and laboratory features
of patients missed and correctly diagnosed during their first ED visit were compared.
The literature on this subject was also reviewed.
Results A total of 400 patients were included in this study. Fifteen (3.75%) patients were
considered to be misdiagnoses, the most common misdiagnosis being acute gastroenteritis
(26.6%). Thirty-three percent of misdiagnosed patients had undergone an ultrasound
compared with 87% of correctly diagnosed patients (p < 0.05).
Conclusion Our incidence of missed appendicitis compares favorably with the 6.9 to 27.6% incidence
reported in the literature. Our relatively low incidence may be a result of medical
practice, especially during night shifts, and the availability of ultrasound 24 hours
a day.
Keywords
missed appendicitis - ultrasound - emergency department - abdominal pain
