Galai Tut, Beloosesky Osnat Zmora, Scolnik Dennis, Rimon Ayelet, Glatstein Miguel
Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children's Hospital, University of Tel Aviv, Israel.
Department of Pediatric Surgery, Dana Dwek Children's Hospital, Tel Aviv, Israel.
Eur J Pediatr Surg. 2017 Apr;27(2):138-141. doi: 10.1055/s-0035-1570757. Epub 2016 Jan 8.
Missed appendicitis is a frequent cause of professional liability for emergency department (ED) physicians. Our objective was to assess and compare the presentations of patients in whom the diagnosis of appendicitis was missed with those in whom it was correctly diagnosed on their first ED visit and to identify the clinical features that characterized the two groups. This study is a retrospective review of all ED children with proven appendicitis between January 2010 and December 2013. Historical, clinical, and laboratory features of patients missed and correctly diagnosed during their first ED visit were compared. The literature on this subject was also reviewed. A total of 400 patients were included in this study. Fifteen (3.75%) patients were considered to be misdiagnoses, the most common misdiagnosis being acute gastroenteritis (26.6%). Thirty-three percent of misdiagnosed patients had undergone an ultrasound compared with 87% of correctly diagnosed patients ( < 0.05). Our incidence of missed appendicitis compares favorably with the 6.9 to 27.6% incidence reported in the literature. Our relatively low incidence may be a result of medical practice, especially during night shifts, and the availability of ultrasound 24 hours a day.
阑尾炎漏诊是急诊科医生职业责任的常见原因。我们的目的是评估和比较阑尾炎诊断被漏诊的患者与首次到急诊科就诊时被正确诊断的患者的表现，并确定两组患者的临床特征。 本研究是对2010年1月至2013年12月期间所有经证实患有阑尾炎的急诊科儿童进行的回顾性研究。比较了首次到急诊科就诊时被漏诊和正确诊断的患者的病史、临床和实验室特征。还查阅了关于该主题的文献。 本研究共纳入400例患者。15例（3.75%）患者被认为是误诊，最常见的误诊是急性胃肠炎（26.6%）。33%的误诊患者接受了超声检查，而正确诊断的患者中这一比例为87%（P<0.05）。 我们阑尾炎漏诊的发生率与文献报道的6.9%至27.6%的发生率相比更有利。我们相对较低的发生率可能是医疗实践的结果，尤其是在夜班期间，以及每天24小时都可进行超声检查。
