Missed Opportunity for Initial Diagnosis in Children With Complex Appendicitis.

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE Pediatric emergency care Pub Date : 2024-12-30 DOI:10.1097/PEC.0000000000003326

Shruthi Srinivas, Wendy Jo Svetanoff, Sidhant Kalsotra, Brenna Rachwal, Taha Akbar, Kristine L Griffin, Madeline Su, Brian Kenney, Kyle Van Arendonk, Gail E Besner

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Abstract

Objectives: Delayed diagnosis of acute appendicitis in children may result in complex appendicitis with appendiceal perforation. Delayed diagnosis can result from missed opportunity for initial diagnosis (MOID) despite medical attention. Studies report MOID of less than 5% in pediatric emergency departments (EDs), but we hypothesized that many MOID occurs outside tertiary care facilities. Our goals were to determine the MOID rate in all presenting facilities in children with complex appendicitis and to identify associated risk factors.

Methods: Children (age ≤18) undergoing appendectomy for complex appendicitis between 2018 and 2022 at a single free-standing academic children's hospital were reviewed. Missed opportunity for initial diagnosis was defined as evaluation for related symptoms without a diagnosis of appendicitis within 7 days prior to appendectomy. Logistic regression and UpSet plots were used to identify associated risk factors.

Results: Of 856 children, 140 (16.4%) had MOID. Most MOID originated from nontertiary facilities [urgent care (38.6%), local EDs (26.4%), primary care (25.0%)] compared to our pediatric ED (11.4%). Compared to single-encounter diagnosis, MOID was associated with younger age (adjusted odds ratio per year [aOR] 0.93, 95% confidence interval [CI]: 0.88-0.97) and non-English/Spanish primary language (aOR 2.61, 95% CI: 1.18-5.76). Uninsured patients had lower MOID (aOR 0.22, 95% CI: 0.05-0.96). Missed opportunity for initial diagnosis was associated with more complications (33.6% vs 19.1%, P < 0.0001), prolonged length of stay (6 vs 4 days, P < 0.0001), and increased readmission (11.4% vs 6.6%, P = 0.044).

Conclusions: Missed opportunity for initial diagnosis of complex appendicitis occurs in nontertiary care facilities, is more common in younger children and non-English/Spanish speakers, and is associated with worse outcomes, highlighting the need for interpreters and algorithmic evaluation in nontertiary care facilities.

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儿童复杂阑尾炎错失初步诊断机会。

目的：小儿急性阑尾炎诊断迟缓可能导致复杂阑尾炎伴阑尾穿孔。延误诊断可能是由于错过了初步诊断（MOID）的机会，尽管医疗护理。研究报告儿科急诊科（ed）的MOID低于5%，但我们假设许多MOID发生在三级医疗机构之外。我们的目的是确定复杂阑尾炎患儿在所有就诊机构的MOID率，并确定相关的危险因素。方法：回顾性分析某独立学术儿童医院2018 - 2022年因复杂阑尾炎行阑尾切除术的儿童（年龄≤18岁）。错失初步诊断的机会定义为阑尾切除术前7天内未诊断出阑尾炎而对相关症状进行评估。采用Logistic回归和不安图来确定相关的危险因素。结果：856例患儿中，140例（16.4%）发生MOID。大多数MOID来自非三级医疗机构[急诊（38.6%），地方急诊科（26.4%），初级保健（25.0%）]，而我们的儿科急诊科（11.4%）。与单次诊断相比，MOID与年龄较小（每年调整优势比[aOR] 0.93, 95%可信区间[CI]: 0.88-0.97）和非英语/西班牙语主要语言相关（aOR 2.61, 95% CI: 1.18-5.76）。未参保患者的MOID较低（aOR 0.22, 95% CI: 0.05-0.96）。错过初次诊断机会的患者并发症较多（33.6% vs 19.1%, P < 0.0001），住院时间延长（6天vs 4天，P < 0.0001），再入院率增加（11.4% vs 6.6%, P = 0.044）。结论：复杂阑尾炎的初始诊断机会错过发生在非三级医疗机构中，更常见于年龄较小的儿童和非英语/西班牙语人群，并且与较差的结果相关，这突出了在非三级医疗机构中对口译员和算法评估的需求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric emergency care 医学-急救医学

CiteScore

2.40

自引率

14.30%

发文量

577

审稿时长

3-6 weeks

期刊介绍： Pediatric Emergency Care®, features clinically relevant original articles with an EM perspective on the care of acutely ill or injured children and adolescents. The journal is aimed at both the pediatrician who wants to know more about treating and being compensated for minor emergency cases and the emergency physicians who must treat children or adolescents in more than one case in there.