U.S. Connecticut New Britain General Hospital led by Dr. Louis Graff multi-center study group of patients suspected of appendicitis surgery and hospital emergency room patients with abdominal pain, retrospective study found that doctors and patients false negative clinical diagnosis and prognosis bad about.
Researchers analyzed two categories of patients trying to find out the causes of misdiagnosis of appendicitis.
The researchers analyzed the Connecticut state line in 12 hospitals of 1026 cases of appendicitis history of hospitalization were recorded and analyzed eight hospital emergency room records of 1118 cases of abdominal pain patients (patients in the 1118 cases, 44 were diagnosed as appendicitis) . According to the signs and symptoms of emergency patients with a history of records, with Alvarado score of the patients carried out an evaluation of abdominal pain.
False-negative among the various hospitals were significantly different, from 10.6 to 27.8 percent, an average of 18.9%. Because the initial wrong diagnosis, missed diagnosis rate was significantly different between hospitals, emergency rooms an average false negative rate of 10.4%, the average admission rate of 8.2% false negative. Hospitalized for more than 20 hours when the diagnosis of appendicitis in surgical hospital, called the rate of misdiagnosis. False positive rate (refer to appendix operation was normal) averaged 10.5%.
False negative diagnosis of doctors and delay surgery can have negative consequences such as perforation and abscess formation. No complications of appendicitis surgery from the time of visits to an average of 13.8 hours, perforated appendicitis operation time from attendance to an average of 24.3 hours to 24.3 hours were abscess formation.
Initially missed the signs and symptoms of appendicitis patients significantly higher than the final few patients to make the diagnosis of appendicitis. True appendicitis patients Alvarado score of 6.5 points, false-negative patients in the emergency room of a score of 2.0 points, false-negative patients in the inpatient score of 5.9 points. False-positive patient's score was 5.7 points.
False positive rate of female patients is about 2.3 times higher than that of men. Appendiceal perforation and abscess formation in the 15 years of age and over 40 high. 15 years of age and patients aged over 40 the incidence of perforated appendicitis were 32.6% and 20.1%, while 16 to 40 years old perforation rate was 13.8%. But the rate of false positive diagnosis in pediatric patients was lower, 13.2%, 16 to 40 years old and 18.5%, while 23.6% of elderly patients.
Dr. Graff results similar to previous literature, especially the line appendectomy and perforation of the duration of symptoms prior to initial medical misdiagnosis relations and relations with the delay in similar operations. In order to timely diagnosis, reduce the serious consequences and unnecessary surgery, doctors for years to research on three major areas: patient and family, surgeon, doctor's diagnosis of newly diagnosed.
Dr. Graff noted that although the surgeon should be on the first 100 years of delayed diagnosis of appendicitis have serious consequences and bear the main responsibility, but responsibility for the last 10 years should not be attributed to a surgeon. One study found that only 27% of 1966 patients admitted to hospital within 24 hours after the surgery, the patient is now 13 hours after admission to an operation. Researchers believe that the admission diagnosis as doctors use advanced technology to patients in other parts of the examination to rule out or confirm the diagnosis, for this reason that part of the explanation for the delay and have serious consequences.
Dr. Graff think we should make full use of the emergency observation room can improve the diagnostic accuracy. Emergency observation room to observe the patient and emergency room visits of patients no significant difference, but the small number of cases, no statistical significance. However, observation room of the Hospital of the abdominal pain diagnostic accuracy was 36.2%, compared with non-high observation room of the hospital.
Should be increased vigilance on the young and old, to enhance the observation and diagnosis of women of reproductive age, reduction of unnecessary surgery.
Medical history may be recorded in this study the accuracy of the impact of missed diagnosis in patients first diagnosed, when 60 to 90 percent and Alvarado score the information is lost. Dr. Graff stress, whether negative information is not about records or records are not detailed and should be for all patients hospitalized because of abdominal pain for further study, recommend the use of electronic medical records.
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