No abstract

Objectives: The purpose of this study was to determine the fraction of children with acute appendicitis who had recent false-negative diagnoses and to analyze the association of a missed diagnosis of appendicitis with patient outcome.Methods: The records of all 816 patients who underwent appendectomy for suspected appendicitis at a free-standing children's hospital between 2007 and 2010 were reviewed. A patient admitted or evaluated in the emergency department (ED), discharged without a diagnosis of appendicitis, and then readmitted with histopathologically confirmed appendicitis within 3 days was considered to have a "missed diagnosis." Outcomes for this missed group were compared to those of the remainder of the appendectomy cohort.Results: Thirty-nine patients with appendicitis (4.8%) were missed at initial presentation. The most common initial discharge diagnoses were acute gastroenteritis (43.6%), constipation (10.3%), and emesis (10.3%). The median duration from the initial evaluation to the appendicitis admission was 28.3 hours (interquartile range [IQR] = 17.0 to 39.6 hours). A missed diagnosis was associated with a longer median hospitalization (5.8 days [IQR = 4.0 to 8.1 days] vs. 2.5 days [IQR = 1.8 to 4.6 days]; p < 0.001), higher rate of perforation (74.4% vs. 29.0%; p < 0.001), higher complication rate (28.2% vs. 10.4%; p = 0.002), and higher rate of reintervention (20.5% vs. 6.2%; p = 0.003).Conclusions: Of children diagnosed with appendicitis, 4.8% may have had a missed opportunity for earlier diagnosis. These false-negative diagnoses are associated with higher rates of perforation, postoperative complications, and need for postoperative interventions, as well as longer hospitalizations.ACADEMIC EMERGENCY MEDICINE 2013; 20:592-596 © 2013 by the Society for Academic Emergency Medicine A cute abdominal pain is one of the most frequent complaints for which children and adolescents seek treatment in the emergency department (ED). Although more than 80,000 pediatric patients underwent appendectomy in the United States in 2009, there were more than 675,000 ED visits for abdominal pain.1,2 As such, the vast majority of children who present with acute abdominal pain do not have appendicitis. Distinguishing between the diagnosis of appendicitis and other common pediatric ailments with overlapping symptoms remains a challenge, even with modern imaging modalities. As a result, the diagnosis of appendicitis is missed all too often. 3-5The natural progression of acute appendicitis to perforation when not recognized and treated expeditiously results in increased morbidity and longer hospitalizations. 4,6 Prior studies have shown that between 5.9 and 27.6% of patients with acute appendicitis had missed opportunities to make the diagnosis earlier, resulting in an increase in the rate of perforation to 33.3% to 50.0% from a baseline of 20.3% to 28.0%. 7,8 That said, data on outcomes for patients with missed diagnoses of appendicitis are limited. The purpose of this study was to determine the fraction of c...

Granulation tissue and tube dislodgement are the most common complications after gastrostomy placement in children. Gender, age, insurance status, and operative technique were not predictive of complications. Emergency department utilization is high in children with gastrostomy tubes.

No abstract