title: Misdiagnosis of Acute Appendicitis in Children Attending the Emergency Department: The Experience of a Large, Tertiary Care Pediatric Hospital.
abstract: BackgroundMissed 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.MethodsThis 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.ResultsA 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).ConclusionOur 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.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children's Hospital, University of Tel Aviv, Israel.
authors.forename: Tut
authors.initials: T
authors.lastname: Galai
authors.affiliation: Department of Pediatric Surgery, Dana Dwek Children's Hospital, Tel Aviv, Israel.
authors.forename: Osnat Zmora
authors.initials: OZ
authors.lastname: Beloosesky
authors.affiliation: Pediatric Emergency Department, Hospital for Sick Kids, Toronto, Ontario, Canada.
authors.forename: Dennis
authors.initials: D
authors.lastname: Scolnik
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children's Hospital, University of Tel Aviv, Israel.
authors.forename: Ayelet
authors.initials: A
authors.lastname: Rimon
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children's Hospital, University of Tel Aviv, Israel.
authors.forename: Miguel
authors.initials: M
authors.lastname: Glatstein
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D001064:Appendicitis / Q000175:diagnosis*; D002648:Child; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D003967:Diarrhea / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000209:etiology; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014839:Vomiting / Q000209:etiology