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The research team also found a missed diagnosis was more common in women and patients with pre-existing medical conditions. In addition, diagnostic tests played a role in who was or was not diagnosed.
"One other finding that was particularly interesting is that patients who received only abdominal X-rays were more likely to be in the potentially missed appendicitis group," Mahajan says.
He notes that this finding suggests the need for health care providers to have better guidance on appropriate use of imaging.
"There is a potential to reduce unnecessary abdominal X-rays for the evaluation of abdominal pain, and use computed tomography (CT) scans for a more select group of patients either in the emergency department or on a follow-up visit," Mahajan says.
But, he notes that just because the study findings suggest that patients who were accurately diagnosed with appendicitis at the initial emergency department visit had more CT scans, the scans shouldn't always be automatically performed.
"We're not saying that CT scans should be used on all cases of abdominal pain," Mahajan says. "Instead, based on the study finding that most cases were diagnosed at the repeat visit, we hope this finding will give guidance to emergency department and other health care providers on when to follow up with patients, as well as when to request advanced imaging." Follow-up care for appendicitis
Mahajan says the study highlights the need for health care providers to follow up with patients.
"Our data suggests that patients with abdominal pain who visit the emergency department may need some form of close follow-up health care to enhance the diagnosis of appendicitis," Mahajan says.
In addition, he says this study can shed further light on the frequency of diagnostic errors.
"This study provides health care providers with guidance regarding follow-up care in order to reduce the burden of diagnostic errors, which is estimated to occur in 12 million people every year in the U.S. and results in billions of dollars of unnecessary health care expenses," Mahajan says.
"Since the majority of diagnostic errors are preventable, our findings add to the current state-of-science to help improve diagnostic quality." Source:
Michigan Medicine - University of Michigan Journal reference:
Mahajan, P., et al. (2020) Factors Associated With Potentially Missed Diagnosis of Appendicitis in the Emergency Department. JAMA Network Open . doi.org/10.1001/jamanetworkopen.2020.0612 .
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