Professional Documents
Culture Documents
Missed Appendicitis
webmm.ahrq.gov
Objectives
At the conclusion of this educational activity, participants should be able to: Appreciate the variable presentation of appendicitis List complications of missed appendicitis Understand the advantages and disadvantages of CT in diagnosing appendicitis Define anchoring and metacognition and state their impact on missed diagnoses List potential strategies to enhance patient safety in the emergency department (ED)
McCaig LF, et al. CDC 2002;326:April 22. Graff L, et al. Acad Emerg Med 2000;7:1244-55.
Abdominal CT in Appendicitis
CT can enhance diagnostic accuracy
Sensitivity 80%-100%
Ege G. et al. Br J Radiol 2002;75:721-5. Maluccio MA. et al. Surg Infect 2001;2:205-11.
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Anchoring
Cognitive error due to reliance on diagnostic assumptions and prior reasoning of previous assessments Transition of care points are high risk for propagation To minimize this type of error, take a step back and think broadly about the casei.e., apply metacognition
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Perforated Appendix
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Intra-abdominal Abscess
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Graff L, et al. Acad Emerg Med 2000;7:1244-55. Mueller BA, et al. NEJM 1986;315:1506-8.
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Take-Home Points
Appendicitis is an uncommon but important cause of abdominal pain in the ED Presentation is often atypical Complications of missed or delayed diagnosis are multiple and morbid To decrease missed appendicitis, consider CT scan, inpatient observation, and/or detailed follow-up instructions Use CT scan with caution
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Consider implementing diagnostic algorithms to ensure that appendicitis is in the differential, even in atypical cases Close the loop by obtaining follow-up on clinical outcomes
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