Failure to Diagnose Appendicitis – A Frequent Source of Malpractice Claims
Posted by: Sanford Goldberg M.D. and Philip Robbins M.D.
Co-Chief Medical Officers for EmPRO Insurance Company
Appendicitis related claims are a relatively common source of medical-surgical malpractice claims1. Appendicitis is often confused with other intra-abdominal processes and should be considered in any patient who presents with acute abdominal pain. An individual might go to a primary physician’s office or ED with complaints of recent onset of nausea, vomiting and nondescript abdominal discomfort for several days. The patient may have a history of recently eating at a restaurant and feel that they require symptomatic treatment for a perceived diagnosis of “food poisoning”. This putative history of acquired gastroenteritis may bias the healthcare provider toward a banal diagnosis other than appendicitis. Despite the similarity to the appearance of gastroenteritis/food borne illness the diagnosis of appendicitis should be a primary consideration in the diagnostic process and the following points should be considered:
- Whether other patient contacts have become similarly ill is an especially important point to explore since the lack thereof reduces the possibility of an acquired infection or toxin
- Age of the patient is also a preeminent consideration since symptoms are often muted or distorted in older patients and the disease is more common in younger patients
- Physical examination of the patient requires a clear differential diagnosis with a focused abdominal survey of various important anatomical zones for pathological findings
Note that only minimal pain medication should be given so as not to mask present or developing symptoms.
Often, when patients are seen in the office setting there is reluctance to send them to the ED for further evaluation. Appendicitis should be strongly considered in patients who have significant abdominal pain, nausea, vomiting, diarrhea, fever and decreased appetite. Further evaluation is then warranted including labs and CT of the abdomen and pelvis.
Many cases of appendicitis are missed because patients do not necessarily present with classic symptomatology. Therefore, consideration should be given to monitoring the patient for a period of time or advising them to go to/return to the ED if symptoms progress.
Being mindful of these pitfalls may help clinicians reduce the likelihood of missing a diagnosis of appendicitis.
1EmPRO is a member of the prestigious CRICO Strategies Comparative Benchmarking System (CBS). The CBS database contains over 450,000 medical malpractice cases and includes the in-depth coding and analysis of member companies’ claims. This allows member companies from across the country to better understand and analyze the causes and costs of medical malpractice cases and to compare their cases with similar companies that insure healthcare providers and facilities.
EmPRO believes it is important to share this valuable information with our Insureds to help you understand the common causes of malpractice claims and help you to mitigate your exposure to such events.
We welcome your comments and feedback.
Sanford Goldberg M.D. S.Goldberg@medmal.com
Philip Robbins M.D. P.Robbins@medmal.com