Nav: Home

Why is appendicitis not always diagnosed in the emergency department?

March 16, 2020

ANN ARBOR, Mich. - While symptoms of
The study, published in
, highlights that appendicitis is one of the most common surgical emergencies in the United States, but previous data show an appendicitis diagnosis is missed in 3.8% to 15% of children and in 5.9% to 23.5% of adults during an emergency department visit.

"In this study, we examined patients that initially presented to an emergency department with symptoms of appendicitis, but were not diagnosed at that first presentation," says the study's lead investigator,

Using insurance claims data, Mahajan and his team found that 6% of adults and 4.4% of children, who initially presented to the emergency department with symptoms associated with appendicitis, weren't diagnosed with appendicitis at the initial visit, but rather, at a repeat health care visit.

"The repeat health care visit could be either again at the emergency department or another health care facility, and the majority of these diagnoses were made within seven days of the initial emergency department visit," says Mahajan, also a member of the

Factors associated with a missed diagnosis

Mahajan and his team investigated factors that could explain why a diagnosis of appendicitis was missed during the patient's first visit to the emergency department.

He explains that symptoms of appendicitis are common, including abdominal pain, constipation, nausea and/or vomiting, fever and diarrhea.

"Many instances of potentially missed appendicitis in children and adults were initially labeled as constipation," Mahajan says. "Suggesting that in some instances, cases with appendicitis were either misdiagnosed as constipation or the label of constipation may have led to a particular type of cognitive bias called premature closure, which may have predisposed the provider to a missed diagnosis."

The research team also found a missed diagnosis was more common in women and patients with pre-existing medical conditions. In addition, diagnostic tests played a role in who was or was not diagnosed.

"One other finding that was particularly interesting is that patients who received only abdominal X-rays were more likely to be in the potentially missed appendicitis group," Mahajan says.

He notes that this finding suggests the need for health care providers to have better guidance on appropriate use of imaging.

"There is a potential to reduce unnecessary abdominal X-rays for the evaluation of abdominal pain, and use computed tomography (CT) scans for a more select group of patients either in the emergency department or on a follow-up visit," Mahajan says.

But, he notes that just because the study findings suggest that patients who were accurately diagnosed with appendicitis at the initial emergency department visit had more CT scans, the scans shouldn't always be automatically performed.

"We're not saying that CT scans should be used on all cases of abdominal pain," Mahajan says. "Instead, based on the study finding that most cases were diagnosed at the repeat visit, we hope this finding will give guidance to emergency department and other health care providers on when to follow up with patients, as well as when to request advanced imaging."

Follow-up care for appendicitis

Mahajan says the study highlights the need for health care providers to follow up with patients.

"Our data suggests that patients with abdominal pain who visit the emergency department may need some form of close follow-up health care to enhance the diagnosis of appendicitis," Mahajan says.

In addition, he says this study can shed further light on the frequency of diagnostic errors.

"This study provides health care providers with guidance regarding follow-up care in order to reduce the burden of diagnostic errors, which is estimated to occur in 12 million people every year in the U.S. and results in billions of dollars of unnecessary health care expenses," Mahajan says.

"Since the majority of diagnostic errors are preventable, our findings add to the current state-of-science to help improve diagnostic quality."
-end-


Michigan Medicine - University of Michigan

Related Ann Arbor Articles:

Fatigue in Parkinson's disease is associated with lower diastolic blood pressure
Amsterdam, NL, August 22, 2019 - Fatigue is a common debilitating symptom in Parkinson's disease (PD).
Ex-Tropical Cyclone Ann moving over Australia's Cape York Peninsula
NASA-NOAA's Suomi NPP satellite passed over the Southern Pacific Ocean and captured a visible image of the remnants of Tropical Cyclone Ann moving over Queensland's Cape York Peninsula.
NASA finds tropical cyclone Ann over the great barrier reef
Australia's world-famous Great Barrier Reef is located in the Coral Sea, east of Queensland and on May 14, 2019 Tropical Cyclone Ann was moving over it.
NASA-NOAA satellite catches Tropical Cyclone Ann threatening Queensland
NASA-NOAA's Suomi NPP satellite passed over the Southern Pacific Ocean and captured a visible image of Tropical Cyclone Ann in the Coral Sea, off the east coast of Queensland, Australia.
Non-invasive imaging technique valid for identifying small airway disease in lung
Landmark study confirms ability of non-invasive imaging technique to identify early signs of chronic obstructive pulmonary disease (COPD).
2016 Lupus Insight Prize presented to Dr. Ann Marshak-Rothstein
The 2016 Lupus Insight Prize was awarded to Ann Marshak-Rothstein, Ph.D., University of Massachusetts Medical School, for a project with great promise to improve the treatment of lupus-related skin disease.
U-M Health System announces clinical affiliation with CVS Health
The University of Michigan Health System has established a new affiliation with CVS Health to continue to improve the health care experience for patients.
Who benefits from a catheter -- and who doesn't? New guide aims to protect patients
What's the only thing worse than having a urinary catheter when you're in the hospital?
Women veterans younger, more depressed when referred for heart test
Women veterans face a different home front battle with heart disease.
New test helps guide treatment for bone marrow transplant patients with graft vs. host disease
Innovative scoring system uses 'Ann Arbor raft versus host disease score' to better predict how patients will respond, minimize side effects

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Climate Mindset
In the past few months, human beings have come together to fight a global threat. This hour, TED speakers explore how our response can be the catalyst to fight another global crisis: climate change. Guests include political strategist Tom Rivett-Carnac, diplomat Christiana Figueres, climate justice activist Xiye Bastida, and writer, illustrator, and artist Oliver Jeffers.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Speedy Beet
There are few musical moments more well-worn than the first four notes of Beethoven's Fifth Symphony. But in this short, we find out that Beethoven might have made a last-ditch effort to keep his music from ever feeling familiar, to keep pushing his listeners to a kind of psychological limit. Big thanks to our Brooklyn Philharmonic musicians: Deborah Buck and Suzy Perelman on violin, Arash Amini on cello, and Ah Ling Neu on viola. And check out The First Four Notes, Matthew Guerrieri's book on Beethoven's Fifth. Support Radiolab today at Radiolab.org/donate.