• Kenneth A Michelson, Richard G Bachur, Joseph A Grubenhoff, Andrea T Cruz, Pradip P Chaudhari, Scott D Reeves, John J Porter, Michael C Monuteaux, Arianna H Dart, and Jonathan A Finkelstein.
• Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
• J Emerg Med. 2023 Jul 1; 65 (1): e9e18e9-e18.

BackgroundMissed diagnosis can predispose to worse condition-specific outcomes.ObjectiveTo determine 90-day complication rates and hospital utilization after a missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis (DKA), and sepsis.MethodsWe evaluated patients under 21 years of age visiting five pediatric emergency departments (EDs) with a study condition. Case patients had a preceding ED visit within 7 days of diagnosis and underwent case review to confirm a missed diagnosis. Control patients had no preceding ED visit. We compared complication rates and utilization between case and control patients after adjusting for age, sex, and insurance.ResultsWe analyzed 29,398 children with appendicitis, 5366 with DKA, and 3622 with sepsis, of whom 429, 33, and 46, respectively, had a missed diagnosis. Patients with missed diagnosis of appendicitis or DKA had more hospital days and readmissions; there were no significant differences for those with sepsis. Those with missed appendicitis were more likely to have abdominal abscess drainage (adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 2.4-3.6) or perforated appendicitis (aOR 3.1, 95% CI 2.5-3.8). Those with missed DKA were more likely to have cerebral edema (aOR 4.6, 95% CI 1.5-11.3), mechanical ventilation (aOR 13.4, 95% CI 3.8-37.1), or death (aOR 28.4, 95% CI 1.4-207.5). Those with missed sepsis were less likely to have mechanical ventilation (aOR 0.5, 95% CI 0.2-0.9). Other illness complications were not significantly different by missed diagnosis.ConclusionsChildren with delayed diagnosis of appendicitis or new-onset DKA had a higher risk of 90-day complications and hospital utilization than those with a timely diagnosis.Copyright © 2023 Elsevier Inc. All rights reserved.

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