The Clinical and Economic Correlates of Misdiagnosed Appendicitis

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Abstract
THE LIFETIME risk of appendectomy is 12% for men and 25% for women, making it the most commonly performed emergency operation in the world.1,2 Though considered a straightforward diagnosis by clinicians, a high rate of misdiagnosis—often referred to as negative appendectomy (NA)—suggests otherwise. A recent population-based analysis3 has confirmed the findings of smaller clinical studies2,4,5 that in more than 15% of appendectomies performed there is no pathologic evidence of appendicitis. In some high-risk populations, such as women of reproductive ages, the population-based rate of unnecessary appendectomy is as high as 26%.3 While computed tomographic scanning, ultrasonography, and laparoscopy have been advocated to improve accuracy in the diagnosis of appendicitis, the benefit of these modalities in clinical trials6 has not been realized in general practice.4 In fact, diagnostic accuracy on a population level has not improved during the last 15 years despite the widespread availability of such testing.3