Why does the clinical diagnosis fail in suspected appendicitis?

被引:33
作者
Andersson, RE [1 ]
Hugander, AP
Ghazi, SH
Ravn, H
Offenbartl, SK
Nyström, PO
Olaison, GP
机构
[1] Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden
[2] Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden
[3] Highlands Hosp, Dept Surg, Eksjo, Sweden
[4] Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden
关键词
appendicitis; appendicectomy; diagnostic errors; gender; abdominal pain; laboratory examinations;
D O I
10.1080/110241500447434
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To identify systematic errors in surgeons' estimations of the importance of diagnostic variables in the decision to explore patients with suspected appendicitis. Design: Prospective case series. Setting: Two emergency departments, Sweden. Patients: 496 patients with suspected appendicitis on admission, of whom 194 had a correct operation for appendicitis and 59 had a negative exploration. Main outcome measures: Predictors of a negative exploration expressed as the odds ratio (OR) for negative exploration. Variables influence on the decision to operate, expressed as the OR for operation, compared with the true diagnostic importance, expressed as the OR for appendicitis. Results: Predictors of negative explorations were high ratings in variables describing pain and tenderness (patient's perceived pain, abdominal tenderness, rebound tenderness, guarding or rectal tenderness), weak or absent inflammatory response, female sex, long duration of symptoms and absence of vomiting, with OR of 1.8-3.0. Pain and tenderness had too strong an influence on the decision to operate whereas the lack of an inflammatory response, no vomiting, and long duration of symptoms were not given enough attention. There was no sex difference in the proportion of patients with non-surgical abdominal pain (NSAP) who were operated on, but NSAP was more common and appendicitis less common among women, leading to a larger proportion of negative appendicectomies among women. Conclusion: Negative explorations in patients with suspected appendicitis are related to systematic errors in the clinical diagnosis with too strong an emphasis on pain and tenderness, and too little attention paid to duration of symptoms and objective signs of inflammation. Rectal tenderness is not a sign of appendicitis. The risk of diagnostic errors is similar in men and women.
引用
收藏
页码:796 / 802
页数:7
相关论文
共 24 条
[1]   A PRACTICAL SCORE FOR THE EARLY DIAGNOSIS OF ACUTE APPENDICITIS [J].
ALVARADO, A .
ANNALS OF EMERGENCY MEDICINE, 1986, 15 (05) :557-564
[2]   INDICATIONS FOR OPERATION IN SUSPECTED APPENDICITIS AND INCIDENCE OF PERFORATION [J].
ANDERSSON, R ;
HUGANDER, A ;
THULIN, A ;
NYSTROM, PO ;
OLAISON, G .
BRITISH MEDICAL JOURNAL, 1994, 308 (6921) :107-110
[3]   Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis [J].
Andersson, RE ;
Hugander, AP ;
Ghazi, SH ;
Ravn, H ;
Offenbartl, SK ;
Nyström, PO ;
Olaison, GP .
WORLD JOURNAL OF SURGERY, 1999, 23 (02) :133-140
[4]  
ANDERSSON RE, 1992, EUR J SURG, V158, P37
[5]   APPENDICITIS NEAR ITS CENTENARY [J].
BERRY, J ;
MALT, RA .
ANNALS OF SURGERY, 1984, 200 (05) :567-575
[6]  
BJERREGAARD B, 1983, METHOD INFORM MED, V22, P15
[7]   SIGNIFICANCE OF A POSITIVE RECTAL EXAMINATION IN ACUTE APPENDICITIS [J].
BONELLO, JC ;
ABRAMS, JS .
DISEASES OF THE COLON & RECTUM, 1979, 22 (02) :97-101
[8]  
BURKITT G, 1990, ESSENTIAL SURG PROBL, P289
[9]   RECTAL EXAMINATION AND ACUTE APPENDICITIS [J].
DICKSON, AP ;
MACKINLAY, GA .
ARCHIVES OF DISEASE IN CHILDHOOD, 1985, 60 (07) :666-667
[10]   RECTAL EXAMINATION IN PATIENTS WITH PAIN IN THE RIGHT LOWER QUADRANT OF THE ABDOMEN [J].
DIXON, JM ;
ELTON, RA ;
RAINEY, JB ;
MACLEOD, DAD .
BRITISH MEDICAL JOURNAL, 1991, 302 (6773) :386-388