Clinician factors associated with delayed diagnosis of appendicitis

Diagnosis (Berl). 2022 Dec 12;10(2):183-186. doi: 10.1515/dx-2022-0119. eCollection 2023 May 1.


Objectives: To evaluate the association of clinician demographics and practice patterns with delayed diagnosis of appendicitis.

Methods: We included children with appendicitis at 13 regional emergency departments (EDs). We screened patients with a previous ED visit within 7 days for delayed diagnosis by chart review. We evaluated the association of clinician characteristics using logistic regression with random intercepts for site and clinician and delay as the outcome.

Results: Among 7,452 children with appendicitis, 105 (1.4%) had delayed diagnosis. Clinicians in the lowest quartile of obtaining blood in their general practice were more likely to have delayed diagnosis (odds ratio 4.9 compared to highest quartile, 95% confidence interval 1.8, 13.8). Clinicians' imaging rates, specialty, sex, and experience were not associated with delayed diagnosis.

Conclusions: Clinicians who used more blood tests in their general practice had a lower risk of delayed diagnosis of appendicitis, possible evidence that lower risk tolerance has benefits.

Keywords: appendicitis; emergency department; emergency medicine; risk tolerance.

Publication types

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

MeSH terms

  • Appendicitis* / complications
  • Appendicitis* / diagnosis
  • Child
  • Delayed Diagnosis
  • Emergency Service, Hospital
  • Humans
  • Medicine*
  • Retrospective Studies