Malpractice in the Emergency Room: A Critical Review of Undiagnosed Appendicitis Cases and Legal Actions

Abstract

A review of 1,400 potentially compensable events on file at a major insurer of hospitals in Pennsylvania demonstrated 22 cases of missed appendicitis. Each case was reviewed by three health care professionals, using standard criteria for physical examination of the abdomen as published in generally accepted text books. These cases were gleaned from a population of over 27,000,000 emergency room visits. The typical patient presented less than 24 hours after onset of symptoms. All had major elements of the history or physical examination that strongly suggested the pos sible diagnosis of appendicitis. Common elements that led to the failure to diagnose were cursoriness of examination as evidenced by documentation of the physical examination and inadequacy of follow-up and misinterpretation of existing signs and symp toms. Remedial actions are suggested.