Die durch Diagnosefehler bedingte Verzögerung der operativen Behandlung der akuten Appendizitis – Erfahrungen der Norddeutschen Schlichtungsstelle für Arzthaftpflichtfragen

Abstract

From 2000 to 2012, 447 panel proceedings concerning acute appendicitis were evaluated. 271 cases (57%) were related to alleged diagnostic malpractice. This was confirmed in 176 cases (67%). The following medical specialities were involved (m=quote of malpractice): general surgery 33%, m=51%; paediatric surgery 3%, m=44%; general practitioner and prehospital emergency services 24%, m=62%; internal medicine 19%, m=70%; paediatrics 13%, m=57%; gynaecology 3%, m=91%; urology 2%, m=17%. The most frequent misdiagnosis was gastroenteritis (43% in adults, 69% in children), obviously based on the concomitant symptom of diarrhoea. Surgery revealed all stages of advanced appendicitis up to peritoneal sepsis, organic failure and death (n=5). The evaluation of the files and the experts' reports of the 176 cases of diagnostic malpractice allowed to define the following basic failures, which led to unjustified delay of operation: careless history-taking, no or incomplete physical examination, no follow-up investigations, incorrect interpretation of the patient's complaints and clinical findings, no or incomplete documentation. Conducting a thorough investigation is essential to avoiding diagnostic malpractice. Internal analysis of failures or near failures may contribute to reducing the number of future cases of malpractice.