The following is a summary of “OUTCOMES OF MISSED DIAGNOSIS OF PEDIATRIC APPENDICITIS, NEW-ONSET DIABETIC KETOACIDOSIS, AND SEPSIS IN FIVE PEDIATRIC HOSPITALS,” published in the July 2023 issue of Emergency Medicine by Michelson et al.

Failure to accurately diagnose a medical condition can increase the likelihood of experiencing more severe outcomes specific to that condition. To assess the rates of complications within 90 days and the utilization of hospital resources after an undetected diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis (DKA), and sepsis. Researchers assessed individuals under 21 who presented at five pediatric emergency departments (EDs) with a specified medical condition. The patients under consideration had a prior emergency department visit within 7 days of diagnosis. A thorough examination of their cases was conducted to validate the occurrence of an overlooked diagnosis. The control group consisted of patients who did not have a prior emergency department (ED) visit. 

Researchers compared complication rates and utilization among case and control patients while accounting for age, sex, and insurance coverage. Researchers researched a cohort of 29,398 pediatric patients diagnosed with appendicitis, 5,366 with diabetic ketoacidosis (DKA), and 3622 with sepsis. Among these patients, 429 cases of appendicitis, 33 cases of DKA, and 46 cases of sepsis were identified as having experienced a missed diagnosis. Patients presenting with undiagnosed appendicitis or diabetic ketoacidosis (DKA) exhibited prolonged hospital stays and higher rates of readmissions. Conversely, individuals with sepsis did not demonstrate notable disparities in these outcomes. Individuals who experienced a failure to diagnose appendicitis had a higher likelihood of requiring drainage for abdominal abscess (adjusted odds ratio [aOR] 3.0, 95% CI 2.4–3.6) or developing a perforated appendix (aOR 3.1, 95% CI 2.5–3.8). 

Individuals who experienced a failure to diagnose diabetic ketoacidosis (DKA) had a higher likelihood of developing cerebral edema (adjusted odds ratio [aOR] 4.6, 95% CI 1.5–11.3), requiring mechanical ventilation (aOR 13.4, 95% CI 3.8–37.1), or experiencing mortality (aOR 28.4, 95% CI 1.4–207.5). Individuals not diagnosed with sepsis had a decreased likelihood of requiring mechanical ventilation (adjusted odds ratio [aOR] 0.5, 95% CI 0.2–0.9). There were no significant variations in other medical complications due to the failure to diagnose. Pediatric patients with delayed diagnosis of appendicitis or the onset of new diabetic ketoacidosis (DKA) exhibited an increased susceptibility to experiencing complications within 90 days and requiring more frequent hospital utilization than those who received a prompt diagnosis.

Source: sciencedirect.com/science/article/abs/pii/S0736467923002299