Clinician factors associated with delayed diagnosis of appendicitis

Kenneth A. Michelson; Finn L.E. McGarghan; Emma E. Patterson; Mark L. Waltzman; Margaret E. Samuels-Kalow; Kimberly F. Greco

doi:10.1515/dx-2022-0119

Article

Clinician factors associated with delayed diagnosis of appendicitis

Kenneth A. Michelson , Finn L.E. McGarghan , Emma E. Patterson , Mark L. Waltzman , Margaret E. Samuels-Kalow and Kimberly F. Greco

Published/Copyright: December 12, 2022

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From the journal Diagnosis Volume 10 Issue 2

Abstract

Objectives

To evaluate the association of clinician demographics and practice patterns with delayed diagnosis of appendicitis.

Methods

We included children with appendicitis at 13 regional emergency departments (EDs). We screened patients with a previous ED visit within 7 days for delayed diagnosis by chart review. We evaluated the association of clinician characteristics using logistic regression with random intercepts for site and clinician and delay as the outcome.

Results

Among 7,452 children with appendicitis, 105 (1.4%) had delayed diagnosis. Clinicians in the lowest quartile of obtaining blood in their general practice were more likely to have delayed diagnosis (odds ratio 4.9 compared to highest quartile, 95% confidence interval 1.8, 13.8). Clinicians’ imaging rates, specialty, sex, and experience were not associated with delayed diagnosis.

Conclusions

Clinicians who used more blood tests in their general practice had a lower risk of delayed diagnosis of appendicitis, possible evidence that lower risk tolerance has benefits.

Keywords: appendicitis; emergency department; emergency medicine; risk tolerance

Corresponding author: Kenneth A. Michelson, MD, MPH, Division of Emergency Medicine, Boston Children’s Hospital, 300 Longwood Ave, BCH 3066, Boston, MA 02115, USA; and Department of Pediatrics, South Shore Hospital, Weymouth, MA, USA, E-mail: kenneth.michelson@childrens.harvard.edu

Research funding: Dr. Michelson received funding through the CRICO Foundation.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: The local Institutional Review Board deemed the study exempt from review.

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Received: 2022-11-04

Accepted: 2022-11-22

Published Online: 2022-12-12

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Articles in the same Issue

https://doi.org/10.1515/dx-2022-0119

Keywords for this article

appendicitis; emergency department; emergency medicine; risk tolerance