Is there evidence for a racial difference in misdiagnosis in patients explored for appendicitis?

A retrospective review was conducted to determine if there were identifiable racial markers in patients who were explored and misdiagnosed as having appendicitis. Between May 1983 and May 1987, 100 patients were explored for appendicitis. There were 65 whites and 35 blacks with a male predominance in each group. The age range was 4 to 70 years with a mean of 47 years; 30% of each group was in the pediatric age range (less than 17 years old). Eight patients had a normal appendix including two blacks: a 20-year-old male with no pathologic diagnosis and a 42-year-old female with a ruptured cornual pregnancy. Although the sample size was small, there was a trend toward a lower white blood cell count in blacks when appendicitis was confirmed at surgery (11,000 cells/microL +/- 3,000 v 17,000 cells/microL +/- 3,000). The following conclusions can be drawn: (1) the accuracy of diagnosis should be considerably lower than the 20% commonly quoted; (2) the likelihood of an incorrect diagnosis appears to be higher in adults in both groups without a sexual predilection; and (3) there may be a trend toward a higher initial white blood count in whites compared with blacks with acute appendicitis.