Tips to Prevent Delayed Diagnosis of Pediatric Appendicitis

Abstract

Research Article| December 01 2021 Tips to Prevent Delayed Diagnosis of Pediatric Appendicitis AAP Grand Rounds (2021) 46 (6): 64. https://doi.org/10.1542/gr.46-6-64 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Tips to Prevent Delayed Diagnosis of Pediatric Appendicitis. AAP Grand Rounds December 2021; 46 (6): 64. https://doi.org/10.1542/gr.46-6-64 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: appendicitis, delayed diagnosis Source: Michelson KA, Reeves SD, Grubenhoff JA, et al. Clinical features and preventability of delayed diagnosis of pediatric appendicitis. JAMA Netw Open. 2021;4(8):e2122248. doi: https://doi.org/10.1001/jamanetworkopen.2021.22248Google Scholar Investigators from multiple institutions conducted a case control study to evaluate clinical features associated with a delayed diagnosis of appendicitis in children and to assess how frequently the delay in diagnosis might have been preventable. Study participants were patients <21 years old diagnosed with appendicitis at 1 of 5 pediatric emergency departments (EDs) in the US between 2010 and 2019. Cases were children with 2 ED visits within 7 days leading to a diagnosis of appendicitis and were identified by reviewing diagnostic codes available in the Pediatric Health Information System (PHIS). Controls were patients with a diagnosis of appendicitis made at the time of their initial ED visit who had been previously enrolled in a prospective study at 1 of the participating EDs between 2010 and 2013. Demographic and symptom information were collected systematically on control patients at the time of their ED visit. The medical records of cases were reviewed and demographic and clinical data from the 2 ED visits abstracted. Using a validated scoring system, the Modified Safer DX checklist, the record from the initial ED visit in cases was systematically reviewed and the preventability of the missed diagnosis classified as “likely,” “possibly,” or “unlikely” preventable. Logistic regression was used to compare the presence of specific clinical features of appendicitis observed during the initial ED visit for cases compared to ED visit in controls. In a second model, “care features” such as use of specific medications or imaging were included. Length of stay (LOS) and rates of perforation in cases and controls also were compared. Data were analyzed on 748 children with a mean age of 10.2 ±4.3 years, including 471 cases and 277 controls. Overall, 109 (23.1%) of delayed diagnoses of appendicitis in cases were judged to be unlikely preventable, 247 (52.4%) possibly, and 115 (24.4%) likely. Compared to clinical features in controls, at their initial ED visit case patients were significantly more likely to have abdominal pain present for 48-96 hours (vs <24 hours; odds ratio [OR], 2.84; 95% confidence interval [CI], 1.16, 4.97) and less likely to have pain with walking (OR, 0.16; 95% CI, 0.10, 0.25), maximal pain in right lower quadrant (OR, 0.12; 95% CI, 0.07, 0.19), or abdominal guarding (OR, 0.33; 95% CI, 0.21, 0.51). In the model including care features, cases were more likely to have received non-steroidal anti-inflammatory drugs (OR, 3.78; 95% CI, 2.10, 6.80) and ondansetron (OR, 1.99; 95% CI, 1.10, 3.61), less likely to have received opioids (OR, 0.26; 95% CI, 0.14, 0.49), and less likely to have an ultrasound examination (OR, 0.13; 95% CI, 0.08, 0.24). LOS was longer in cases than controls (mean difference, 2.8 days; 95% CI 2.3, 3.4), and risk of perforation was higher in cases (OR, 7.8; 95% CI, 5.5, 11.3). The authors... You do not currently have access to this content.