Pediatric Appendicitis: Association of Chief Complaint With Missed Appendicitis.
Pediatr Emerg Care
; 36(4): e204-e207, 2020 Apr.
Article
en En
| MEDLINE
| ID: mdl-29324631
ABSTRACT
OBJECTIVES:
We evaluated the association between the emergency department (ED) triage chief complaint and rate of missed appendicitis in children.METHODS:
We performed a retrospective chart review of patients who presented to a pediatric ED and were diagnosed with appendicitis over 5 years (July 1, 2009 to June 30, 2014). We reviewed the medical record for any additional ED visits in the 7 days preceding the diagnosis of appendicitis. Triage chief complaints were classified as "suggestive of appendicitis" (abdominal pain, right lower quadrant pain, or rule out appendicitis) or "nonspecific" (fever, vomiting, dehydration, etc). We evaluated the association between triage chief complaint and missed diagnosis of appendicitis.RESULTS:
We reviewed 1680 patients with appendicitis. In 67 (4%) cases, patients had at least 1 additional ED visit during the week preceding the diagnosis of appendicitis. When comparing those diagnosed with appendicitis at their initial ED visit to those diagnosed after multiple visits, we found no difference in age (9.9 vs 10.1 years, P = 0.665), sex (55.7% vs 49.3% male, P = 0.291), white blood cell count (14.4 vs 12.3 × 103/L, P = 0.115), or presence of fever (19.9% vs 19.4%, P = 0.920). Of patients with a triage chief complaint that was suggestive of appendicitis, 3.8% were missed on their initial ED visit versus 8.8% of those with a nonspecific triage chief complaint (odds ratio, 2.46; 95% confidence interval, 1.1-5.6).CONCLUSIONS:
A triage chief complaint less suggestive of appendicitis was associated with a higher rate of missed appendicitis in a pediatric ED. Our findings further confirm the potential impact of anchoring bias by a triage chief complaint when attempting to diagnose appendicitis.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Apendicitis
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Servicio de Urgencia en Hospital
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Diagnóstico Erróneo
Tipo de estudio:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Revista:
Pediatr Emerg Care
Asunto de la revista:
MEDICINA DE EMERGENCIA
/
PEDIATRIA
Año:
2020
Tipo del documento:
Article