Typical appendicitis can be confidently diagnosed by a first-year medical student. Why then is failure to diagnose appendicitis a common cause of medical negligence action? When is missed diagnosis substandard?
Atypical clinical features which make diagnosis difficult but not necessarily substandard include symptoms lasting more than 48 hours, absence of pain or tenderness in the right lower abdomen, lack of aggravation by movement, and normal white blood cell count.
Conversely, features associated with successful suits for medical malpractice are lack of thorough examination (characteristically no documentation of a rectal examination), administration of narcotic pain medication, diagnosis of gastroenteritis with inadequate criteria, and failure to provide appropriate discharge or follow-up instructions.
In missed appendicitis, look for:
1: a rectal examination
2: administration of narcotics
3: diagnosis of gastroenteritis
4: clear discharge instructions.
For sufficient quantum of damages to justify the risk of failure, there must usually be a probability that rupture of the appendix occurred after the substandard consultation and complications of the rupture which can be attributed with confidence.
Copyright © 2008 Electronic Handbook of Legal Medicine