Appendicitis Misdiagnosis

Appendicitis is an inflammation of the inner lining of the appendix.  The primary causes include infection of the appendix and obstruction of the appendiceal lumen.   Appendectomy (removal of the appendix) is the currently the only cure for appendicitis.  The median age of appendectomies is 22 years, meaning that half of all appendectomies occur under the age 22 and the other half occur over the age 22. Appendectomies carry a 4-15% risk of complications.  Some of this risk clearly cannot be avoided. But some of the risk and some of the serious complications from failing to diagnose and treat appendicitis is often caused by medical malpractice. If you believe you have been injured by medical malpractice, we will be glad to talk to you about what happened to you and figure out whether our attorneys think you may have a claim worth pursuing.

Appendicitis Diagnosis

Diagnosis is often challenging as symptoms mimic several other abdominal conditions.  Furthermore, there is no single accurate diagnostic test for appendicitis.  Classic symptoms of anorexia, pain around the belly button, nausea, lower right quadrant pain and vomiting occur in only 50% of cases.  Further complicating diagnosis, are statistics showing that only 5% of cases involving abdominal pain are actually appendicitis.

Failure to diagnose appendicitis most often occurs due to atypical presentation of symptoms, failure to receive proper physical examination including rectal examination, receipt of analgesia for undiagnosed abdominal pain or symptoms, diagnosis as gastroenteritis, and inadequate follow-up within 12 to 24 hours.  If appendicitis is left untreated, severe complications can occur which include perforation, sepsis or death.

Misdiagnosis of abdominal pain for appendicitis is very common in children presenting with abdominal pain and is estimated to occur at a rate of 28-57% in children under the age of 2-12 years.   In infants misdiagnosis for appendicitis is nearly 100%.  Annual incidence rates are 25 per 10,000 (age 10-17 years), 1-2 per 10,000 (children 4 years and under) and 1.1 per 1000 over all age groups.  250,000 cases of appendicitis are reported in the US annually.  Individual risk rates are approximately 6-9% for development during a lifetime, being slightly higher in men than women.  It has been reported that men have a higher rate of mortality compared to women (1.9% vs. 0.7%).

Perforation is a primary complication associated with appendicitis.  The incidence varies between 16 ND 40 percent.   A higher prevalence is seen in younger age groups (40-57%) as well as older patients (50+), where the incidence ranges between 40-57%.  The increased incidence in the younger and older age group is primarily due to delayed diagnosis or misdiagnosis. 

In a scientific review published earlier this year in American Journal of Surgery, authors reviewed patient data from 1998 to 2007 in the US and found that the rate of negative appendectomies has been declining over the years.  After reviewing 475,651 cases of appendectomies, it was found that 56,252 were negative appendectomies, representing a misdiagnosis rate of 11.8%.  In 1997 it was found that the rate was 14.7% which declined to 8.5% in 2007.  Negative appendectomies are appendectomies where, after removal of the appendix, it is found that the patient did not have appendicitis.  The study also found that of the negative appendectomies, 71.6% were in women compared to 28.4% in men.

It is believed that the higher negative appendectomy rate seen in women is possibly due to misdiagnosis of gynaecological conditions.  In women over the age of 45, malignant disease of the ovary is the most common gynecological condition misdiagnosed as appendicitis.  In younger women it was found that ovarian cyst was most commonly diagnosed as appendicitis.  In contrast, diverticulitis of the colon is the most commonly misdiagnosed condition in men.

It has been suggested that shorter stays in emergency departments, fewer physical findings, lab tests and diagnostic imaging may lead to misdiagnosis as appendicitis.  Though diagnostic imaging such as CT has become more common in evaluating patients presenting with possible appendicitis, a study has demonstrated that diagnosis with CT (computed tomography) may only be applicable to certain people.  Researchers have reported that CT imaging and other advances in medical technology have lead to a decrease in negative appendectomies in women under the age of 45 years.  However, there was no correlation between CT  imaging and rates of appendectomies in women over the age of 45 or men.

Misdiagnosis, leading to negative appendectomies, presents undue risk of complications and costs to both the patient and health care system.  Though misdiagnosis has been shown to be thankfully declining in the U.S., it is still quite prevalent and there does not seem to be any single diagnostic test that may lead to the elimination of the negative appendectomies . 

 

Meningitis Medical Malpractice Claims in Maryland

 

If you or someone you love has suffered as the result of a medical misdiagnosis or failure to properly treat an appendicitis, call a Maryland malpractice attorney at 800-553-8082 or get a free on-line no obligation medical misdiagnosis consultation.