title: [Delayed appendectomy because of diagnostic malpractice: Experiences of the Arbitration Board of the North German Medical Associations].
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.
authors.affiliation: Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hannover, Deutschland. Electronic address: behne@schlichtungsstelle.de.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Vinz
authors.affiliation: Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hannover, Deutschland.
authors.forename: Markward
authors.initials: M
authors.lastname: von Bülow
authors.affiliation: Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hannover, Deutschland.
authors.forename: Johann
authors.initials: J
authors.lastname: Neu
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000331:legislation & jurisprudence*; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D035881:Compensation and Redress / Q000331:legislation & jurisprudence; D057210:Delayed Diagnosis / Q000331:legislation & jurisprudence*; D003951:Diagnostic Errors / Q000331:legislation & jurisprudence*; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D019300:Medical Errors / Q000331:legislation & jurisprudence*; D008511:Medicine; D008875:Middle Aged; D017008:Negotiating; D012955:Societies, Medical; D055815:Young Adult
keywords: Appendicitis; Appendizitis; Arzthaftung; Fehleranalyse; Schlichtungsempfehlung; analysis of failures; arbitration; diagnostic malpractice; diagnostischer Fehler; physician liability