OUTCOMES OF MISSED DIAGNOSIS OF PEDIATRIC APPENDICITIS, NEW-ONSET DIABETIC KETOACIDOSIS, AND SEPSIS IN FIVE PEDIATRIC HOSPITALS

J Emerg Med. 2023 Jul;65(1):e9-e18. doi: 10.1016/j.jemermed.2023.04.006. Epub 2023 Apr 18.

Abstract

Background: Missed diagnosis can predispose to worse condition-specific outcomes.

Objective: To determine 90-day complication rates and hospital utilization after a missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis (DKA), and sepsis.

Methods: We evaluated patients under 21 years of age visiting five pediatric emergency departments (EDs) with a study condition. Case patients had a preceding ED visit within 7 days of diagnosis and underwent case review to confirm a missed diagnosis. Control patients had no preceding ED visit. We compared complication rates and utilization between case and control patients after adjusting for age, sex, and insurance.

Results: We analyzed 29,398 children with appendicitis, 5366 with DKA, and 3622 with sepsis, of whom 429, 33, and 46, respectively, had a missed diagnosis. Patients with missed diagnosis of appendicitis or DKA had more hospital days and readmissions; there were no significant differences for those with sepsis. Those with missed appendicitis were more likely to have abdominal abscess drainage (adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 2.4-3.6) or perforated appendicitis (aOR 3.1, 95% CI 2.5-3.8). Those with missed DKA were more likely to have cerebral edema (aOR 4.6, 95% CI 1.5-11.3), mechanical ventilation (aOR 13.4, 95% CI 3.8-37.1), or death (aOR 28.4, 95% CI 1.4-207.5). Those with missed sepsis were less likely to have mechanical ventilation (aOR 0.5, 95% CI 0.2-0.9). Other illness complications were not significantly different by missed diagnosis.

Conclusions: Children with delayed diagnosis of appendicitis or new-onset DKA had a higher risk of 90-day complications and hospital utilization than those with a timely diagnosis.

Keywords: appendicitis; complication rates; diabetic ketoacidosis; diagnosis delay; diagnostic error; diagnostic safety; missed diagnosis; outcomes; pediatrics; quality improvement; sepsis.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Appendicitis* / complications
  • Appendicitis* / diagnosis
  • Child
  • Diabetes Mellitus*
  • Diabetic Ketoacidosis* / complications
  • Diabetic Ketoacidosis* / diagnosis
  • Hospitals, Pediatric
  • Humans
  • Missed Diagnosis
  • Retrospective Studies
  • Sepsis* / complications
  • Sepsis* / diagnosis