The diagnostic dilemma of identifying perforated appendicitis

Zehra Farzal, Zainab Farzal, Nudrat Khan, Anne Fischer

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Background Despite extensive research, the classification of perforated (PA) versus nonperforated appendicitis (NPA) remains poorly defined. We hypothesize that the variability across specialties in the classification of appendicitis as PA or NPA may be associated with variation in clinical behavior as demonstrated by a variation in length of stay (LOS). Methods Retrospective review of 1311 appendectomies over a 16-mo period from an independent children's hospital allowed a comparison of the diagnostic classification of appendicitis as PA or NPA based on radiology (R), operative (O), and pathology (P) reports. Three groups, P + O (n = 1241), P + R (n = 516), O + R (n = 512) were compared to identify interspecialty discordance in classification. The LOS was analyzed as a proxy for clinical behavior to test if the diagnostic classification was consistent with expected clinical behavior (NPA with LOS ≤48 h and PA with LOS >48 h). Results The subsets P + O, P + R, and O + R revealed a discordance of 11%, 15.7%, and 16.6% within the classification of appendicitis, respectively. Cases designated as PA in all subsets clinically behaved as PA with a mean LOS >48 h (97, 95, and 95 h, respectively), whereas the cases designated as NPA exhibited greater variation from the expected LOS ≤48 h, with means 35, 83, and 62 h, respectively. Conclusions Variability in the classification of appendicitis between specialties suggests an error rate inherent in diagnosis. Standardizing the criteria for classification across specialties may improve the diagnostic accuracy of the type of appendicitis needed to identify best practices for optimal use of hospital resources and for meaningful clinical trials.

Original languageEnglish (US)
Pages (from-to)164-168
Number of pages5
JournalJournal of Surgical Research
Volume199
Issue number1
DOIs
StatePublished - Nov 1 2015

Keywords

  • Cost effectiveness
  • Discordance
  • Pediatric
  • Perforated appendicitis

ASJC Scopus subject areas

  • Surgery

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