Von Titte et al identified reasons for a delay in the diagnosis and treatment of appendicitis. Delayed therapy for acute appendicitis can result in serious morbidity and prolonged hospitalization. The authors are from Massachusetts General Hospital and Harvard Medical School.

Disease-related factors:

(1) uncommon presentation (anatomic variation in location, other)

(2) clinical course not typical  (can occur in the very young or very old)


Patient reasons:

(1) delayed coming in because the patient did not think it was serious

(2) delayed coming in because the patient hoped it would get better

(3) failed to return for followup despite progression of symptoms


Physician reasons:

(1) misdiagnosis, especially if an alternative explanation for abdominal pain is present ( gastroenteritis, diverticulitis, pancreatitis, ovarian cyst, other)

(2) failure to closely follow a patient with an uncertain diagnosis

(3) failure to followup with patient discharged with instructions

(4) releasing a patient who is unreliable or unlikely to return

(5) lack of experience or clinical skill


Other factors not listed by the authors:

(1) presentation during an outbreak of another disease with overlapping symptoms

(2) patient unable to return due to weather, distance, concurrent disease, other

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