APPENDICITIS IN NONPREGNANT WOMEN

Course overview

Appendicitis is one of the most common surgical diagnoses. The failure to diagnose appendicitis is among the five leading causes of adverse outcomes, patient injury and successful litigation involving emergency, urgent care and primary care physicians. For a variety of reasons, the diagnosis of appendicitis is particularly vexing in women. Nonpregnant women with appendicitis are initially misdiagnosed up to 33% of the time, resulting in a greater incidence of perforation, abscess formation, and longer hospital stays. Practitioners must think of appendicitis whenever a female patient presents with abdominal pain, and provide the appropriate evaluation, observation and management. In this activity, we focus on the reasons that practitioners miss or delay the diagnosis of appendicitis in women, using case studies as examples. After completing this activity, practitioners should be able to: identify atypical presentations of appendicitis in nonpregnant patients with acute abdominal pain; recognize the limitations of CT imaging in the diagnosis of appendicitis so that the diagnosis is not missed during the evaluation of abdominal pain; and determine when a patient encounter may involve heuristics and biases, or cognitive dispositions to respond, in order to improve clinical decision-making and reduce diagnostic errors in the evaluation of nonpregnant women with possible appendicitis.