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Cited by 498Appendicitis Diagnosis and ManagementClinical Reasoning and Diagnostic SkillsHealthcare cost, quality, practices

Has Misdiagnosis of Appendicitis Decreased Over Time?: A Population-Based Analysis

Flum, David R., Morris, Arden, Koepsell, Thomas, Dellinger, E. Patchen·2001·JAMA
DOI 10.1001/jama.286.14.1748
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Abstract

CONTEXT: Misdiagnosis of presumed appendicitis is an adverse outcome that leads to unnecessary surgery. Computed tomography, ultrasonography, and laparoscopy have been suggested for use in patients with equivocal signs of appendicitis to decrease unnecessary surgery. OBJECTIVE: To determine if frequency of misdiagnosis preceding appendectomy has decreased with increased availability of computed tomography, ultrasonography, and laparoscopy. DESIGN, SETTING, AND PATIENTS: Retrospective, population-based cohort study of data from a Washington State hospital discharge database for 85 790 residents assigned International Classification of Diseases, Ninth Revision procedure codes for appendectomy, and United States Census Bureau data for 1987-1998. MAIN OUTCOME MEASURE: Population-based age- and sex-standardized incidence of appendectomy with acute appendicitis (perforated or not) or with a normal appendix. RESULTS: Among 63 707 nonincidental appendectomy patients, 84.5% had appendicitis (25.8% with perforation) and 15.5% had no associated diagnosis of appendicitis. After adjusting for age and sex, the population-based incidence of unnecessary appendectomy and of appendicitis with perforation did not change significantly over time. Among women of reproductive age, the population-based incidence of misdiagnosis increased 1% per year (P =.005). The incidence of misdiagnosis increased 8% yearly in patients older than 65 years (P<.001) but did not change significantly in children younger than 5 years (P =.17). The proportion of patients undergoing laparoscopic appendectomy who were misdiagnosed was significantly higher than that of open appendectomy patients (19.6% vs 15.5%; P<.001). CONCLUSION: Contrary to expectation, the frequency of misdiagnosis leading to unnecessary appendectomy has not changed with the introduction of computed tomography, ultrasonography, and laparoscopy, nor has the frequency of perforation decreased. These data suggest that on a population level, diagnosis of appendicitis has not improved with the availability of advanced diagnostic testing.

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  • Endometriosis is a significant contributor to false-positive appendectomy diagnoses, particularly in reproductive-aged women; up to 13-22% of negative appendectomy cases in women are later attributed to underlying gynecologic conditions, most commonly endometriosis.

    “Endometriosis is a significant contributor to false-positive appendectomy diagnoses, particularly in reproductive-aged women. Studies have shown that up to 13–22% of negative appendectomy cases in women are later attributed to underlying gynecologic conditions, most commonly endometriosis [35,36].”

    From Selective Appendectomy in Patients Undergoing Minimally Invasive Surgery for Endometriosis: A Retrospective Cohort Study (2025) · cites this paper as [35]

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Authors
Flum, D. R., Morris, A., Koepsell, T., & Dellinger, E. P.
Affiliations
University of Washington (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2001-10-10
Volume
286
Issue
14
Pages
1748
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.286.14.1748
OpenAlex
W2001814329
Cited by
498
References
23
Citations by year
2026: 8 · 2025: 8 · 2024: 9 · 2023: 15 · 2022: 11 · 2021: 13 · 2020: 19 · 2019: 18 · 2018: 20 · 2017: 17 · 2016: 22 · 2015: 22 · 2014: 17 · 2013: 21 · 2012: 27
FWCI
29.83
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Keywords
appendicitis, misdiagnosis, unnecessary appendectomy, appendiceal perforation, computed tomography, ultrasonography, laparoscopic appendectomy, diagnostic imaging, diagnostic accuracy, temporal trends in diagnosis, women of reproductive age, elderly patients
MeSH terms
Adolescent, Adult, Aged, Appendectomy, Appendicitis, Child, Child, Preschool, Diagnostic Errors, Female, Humans, Male, Middle Aged, Retrospective Studies, Poisson Distribution

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