Certain
patient and presentation factors increase the likelihood of a missed
appendicitis diagnosis in the emergency department, the authors of a study
published online in JAMA Network Open have warned.

Prashant
Mahajan, M.D., from the University of Michigan in Ann Arbor, and colleagues
used commercially insured claims data to identify patients who presented to the
emergency department with undifferentiated symptoms associated with
appendicitis (abdominal pain, constipation, nausea and/or vomiting, fever, and
diarrhea) between 2010 and 2017.

The analysis
included 123,711 patients (81.9 percent adults and 18.1 percent children) who
had a previous emergency department visit within 30 days of an appendicitis
diagnosis.

The researchers
found that the frequency of potentially missed appendicitis was 6 percent among
adults and 4.4 percent among children. A missed diagnosis was less likely for
patients presenting with isolated abdominal pain (adults: adjusted odds ratio
[aOR], 0.65; 95 percent confidence interval [CI], 0.62 to 0.69; P < 0.001; children: aOR, 0.79; 95 percent CI, 0.69 to 0.90; P < 0.001) or with abdominal pain and nausea and/or vomiting (adults: aOR, 0.90; 95 percent CI, 0.84 to 0.97; P = 0.003; children: aOR, 0.84; 95 percent CI, 0.71 to 0.98; P = 0.03).

A missed
diagnosis was more likely among patients with abdominal pain and constipation
(adults: aOR, 1.51; 95 percent CI, 1.31 to 1.75; P < 0.001; children: aOR, 2.43; 95 percent CI, 1.86 to 3.17; P < 0.001). Missed appendicitis was less likely among adult patients who received computed tomography scans at the initial emergency department visit (abdominal pain: aOR, 0.58; 95 percent CI, 0.52 to 0.65; nausea and/or vomiting: aOR, 0.63; 95 percent CI, 0.52 to 0.75; fever: aOR, 0.41; 95 percent CI, 0.29 to 0.58; diarrhea: aOR, 0.83; 95 percent CI, 0.58 to 1.20; and constipation: aOR, 0.60; 95 percent CI, 0.39 to 0.94).

“Regardless
of age, a missed diagnosis of appendicitis was more likely to occur in women,
patients with comorbidities, and patients who experienced abdominal pain
accompanied by constipation,” the authors concluded.

SOURCE: https://www.practiceupdate.com/c/98679/2/6/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_primary&elsca4=primary-care&elsca5=newsletter&rid=NTU2MjE4MTIzNzES1&lid=10332481

REFERENCE:
Mahajan et al: Factors Associated With Potentially Missed Diagnosis of
Appendicitis in the Emergency Department; 
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2762391