Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Feb 28;13(2):e064852.
doi: 10.1136/bmjopen-2022-064852.

Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study

Kenneth A Michelson  1 , Richard G Bachur  2 , Arianna H Dart  2 , Pradip P Chaudhari  3 , Andrea T Cruz  4 , Joseph A Grubenhoff  5   6 , Scott D Reeves  7 , Michael C Monuteaux  2 , Jonathan A Finkelstein  8
Affiliations
Multicenter Study

Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study

Kenneth A Michelson et al. BMJ Open. .

Abstract

Objective: To derive and validate a tool that retrospectively identifies delayed diagnosis of appendicitis in administrative data with high accuracy.

Design: Cross-sectional study.

Setting: Five paediatric emergency departments (EDs).

Participants: 669 patients under 21 years old with possible delayed diagnosis of appendicitis, defined as two ED encounters within 7 days, the second with appendicitis.

Outcome: Delayed diagnosis was defined as appendicitis being present but not diagnosed at the first ED encounter based on standardised record review. The cohort was split into derivation (2/3) and validation (1/3) groups. We derived a prediction rule using logistic regression, with covariates including variables obtainable only from administrative data. The resulting trigger tool was applied to the validation group to determine area under the curve (AUC). Test characteristics were determined at two predicted probability thresholds.

Results: Delayed diagnosis occurred in 471 (70.4%) patients. The tool had an AUC of 0.892 (95% CI 0.858 to 0.925) in the derivation group and 0.859 (95% CI 0.806 to 0.912) in the validation group. The positive predictive value (PPV) for delay at a maximal accuracy threshold was 84.7% (95% CI 78.2% to 89.8%) and identified 87.3% of delayed cases. The PPV at a stricter threshold was 94.9% (95% CI 87.4% to 98.6%) and identified 46.8% of delayed cases.

Conclusions: This tool accurately identified delayed diagnosis of appendicitis. It may be used to screen for potential missed diagnoses or to specifically identify a cohort of children with delayed diagnosis.

Keywords: ACCIDENT & EMERGENCY MEDICINE; Health informatics; PAEDIATRIC SURGERY.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Receiver operating characteristic curves depict the trade-off between sensitivity and false positive rate (1-specificity) in predicting delayed diagnosis. The AUC for the derivation set was 0.892 (95% CI 0.858 to 0.925) and for the validation set was 0.859 (95% CI 0.806 to 0.912). AUC, area under the curve.
See this image and copyright information in PMC

References

    1. Somme S, Bronsert M, Morrato E, et al. . Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 2013;132:e1466–72. 10.1542/peds.2013-1243 - DOI - PubMed
    1. Colvin JM, Bachur R, Kharbanda A. The presentation of appendicitis in preadolescent children. Pediatr Emerg Care 2007;23:849–55. 10.1097/pec.0b013e31815c9d7f - DOI - PubMed
    1. Staab S, Black T, Leonard J, et al. . Diagnostic accuracy of suspected appendicitis. Pediatr Emerg Care 2022;38:e690–6. 10.1097/PEC.0000000000002323 - DOI - PubMed
    1. Sawin RS. Chapter 80 - appendix and meckel’s diverticulum. In: Oldham, Colombani, Foglia, eds. Principles and Practice of Pediatric Surgery. Philadelphia, PA: Lippincott Williams & Wilkins, 2005: 1271–82.
    1. Croskerry P, Sinclair D. Emergency medicine: a practice prone to error? CJEM 2001;3:271–6. 10.1017/s1481803500005765 - DOI - PubMed

Publication types