Characteristics and Outcomes of the Study Population
| Study Population | Missed Diagnosis Subgroupsb | |||||||
|---|---|---|---|---|---|---|---|---|
| Variable | Missed Diagnosis Group, n=90 | Identified Diagnosis Group, n=1,178 | Relative Risk (95% CI) | P Value | Discharged From ED, n=44 | Hospitalized With Wrong Diagnosis, n=47 | Relative Risk (95% CI) | P Value |
| Age, years, median [IQR]a | 29 [18, 43] | 23 [14, 39] | 0.023 | 32 [21, 44] | 23 [16,42] | 0.24 | ||
| Sex | ||||||||
| Female | 38 (42.2) | 436 (37.0) | 1.22 (0.82, 1.83) | 0.37 | 13 (29.5) | 26 (55.3) | 0.56 (0.34, 0.92) | 0.019 |
| Male | 52 (57.8) | 742 (63.0) | 31 (70.5) | 21 (44.7) | ||||
| Symptom onset before first ED encountera | ||||||||
| >24 hours | 35 (44.3) | 584 (51.3) | 0.77 (0.50, 1.18) | 0.25 | 11 (31.4) | 25 (55.6) | 0.56 (0.32, 0.98) | 0.042 |
| ≤24 hours | 44 (55.7) | 554 (48.7) | 24 (68.6) | 20 (44.4) | ||||
| Symptom onset before eventual hospitalizationa | ||||||||
| >24 hours | 55 (64.7) | 584 (51.3) | 1.68 (1.09, 2.58) | 0.018 | 31 (75.6) | 25 (55.6) | 1.66 (0.95, 2.90) | 0.07 |
| ≤24 hours | 30 (35.3) | 554 (48.7) | 10 (24.4) | 20 (44.4) | ||||
| Time between ED first encounter and surgery, hours, median [IQR]b,c | 29.5 [21.6, 45.4] | 9.3 [6.7, 14.1] | <0.001 | 29.6 [21.4, 60.5] | 29.6 [21.6, 40.7] | 0.29 | ||
| Surgical finding | ||||||||
| Complicated appendicitis | 49 (54.4) | 324 (27.5) | 2.87 (1.93, 4.27) | <0.001 | 19 (43.2) | 30 (63.8) | 0.65 (0.42, 1.00) | 0.06 |
| Not complicated | 41 (45.6) | 854 (72.5) | 25 (56.8) | 17 (36.2) | ||||
↵aMissing data: Age in 2 patients; symptom onset before first ED encounter in 51 patients (40/1,178 in identified group; 11/90 in missed group [9/44 in ED discharged subgroup and 2/47 in hospitalized in the wrong department subgroup; in 90 missed patients there were 91 events, see comment b below]); symptom onset before eventual hospitalization in 45 patients (40/1,178 in identified group; 5/90 in missed group [3/44 in ED discharged subgroup and 2/47 in hospitalized in the wrong department subgroup]); time between ED first encounter and surgery in 1 patient who refused surgery and following interval appendectomy had evidence of uncomplicated appendicitis.
↵bOne patient who was discharged from the ED and upon return was hospitalized with the wrong diagnosis in the wrong department was counted twice for a total of 91 events in 90 patients.
↵cPatients with diagnosis of periappendicular abscess are excluded.
Note: Data are presented as n (%) unless otherwise indicated.
ED, emergency department.