Results from a cohort study, reported in JAMA Network Open showed that of 123,711 patients diagnosed with appendicitis, potentially 6 per cent of adults and 4.4 per cent of children were missed during initial visits to the emergency department (ED).
The study included adult and paediatric patients who presented to the ED with undifferentiated symptoms associated with appendicitis, and a previous ED visit within 30 days of an appendicitis diagnosis. For analysis, patients were divided into those who received a diagnosis at the first ED visit, and those who were diagnosed at subsequent visits (potentially misdiagnosed).
Patients with isolated abdominal pain or with abdominal pain and nausea with/without vomiting, were less likely to have missed appendicitis.
Adults in the potentially missed appendicitis group were older and more likely to be female, compared to those diagnosed at the initial ED visit.
Coexistence of two or more comorbidities, those with an absence of abdominal pain, or constipation in combination with abdominal pain, were more likely to have potentially missed appendicitis.
Those who received computed tomography scans at the initial ED visit were less likely to have missed appendicitis. Population-based estimates of the rates of potentially missed appendicitis reveal opportunities for improvement and identification of risk factors of missed diagnosis.