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KMID : 0986720100180020044
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Korean Journal of Medicine and Law
2010 Volume.18 No. 2 p.44 ~ p.71
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Risk Management through a Study Concerning Delayed Diagnosis of Acute Appendicitis in the Emergency Room
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Kim Sun-Deok
Bae Hyun-Ah
Cheon Young-Jin
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Abstract
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PURPOSE: Acute appendicitis is an important surgical disease which has a critical treatment period. However, due to its characteristics, acute appendicitis is a disease with a high incidence rate of delayed diagnosis and misdiagnosis. The purpose of this study is to acknowledge the high incidence rate of delayed diagnosis and misdiagnosis of acute appendicitis in the emergency room (ER) and to form a protocol regarding its proper management.
METHODS: From January 2005 to April 2009, patients who were admitted to ER during 40 months were studied. A retrograde study was done using the patients’medical records. Among 2,020 patients admitted to ER and diagnosed as acute appendicitis and received appendectomy, 87 of the patients whose first impression were not an acute appendicitis (including self-discharged) but received appendectomy later time were studied.
RESULTS: The average age was 28.1 years old and age-group who received a delayed diagnosis were under 10 years of age (21%). Furthermore, women of childbearing age were more likely to have a delayed diagnosis of acute appendicitis than men. Primary symptom of acute appendicitis was right lower quadrant (RLQ) pain (41%), and among the initial diagnostic error were acute gastroenteritis and acute gastritis (47%). Among the patients who took early abdominal CT, 18 patients received wrong initial reading, and 19 patients were self-discharged.
CONCLUSION: Acute appendicitis is a disease which can lead to high probability of medical dispute. The critical factors relating to the risk management of delayed diagnosis of acute appendicitis involves an acknowledgement of additional role of radiological diagnosis based on a clinical diagnosis and a warning that an acute gastritis may progress into an acute appendicitis.
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KEYWORD
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acute appendicitis, diagnostic delay, clinical feature, medico-legal
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