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that perform a high volume of appendectomies are less likely to
misdiagnose children as having appendicitis and less likely to do
unnecessary operations, reports a recent study led by Steven
Fishman, MD, assistant in Surgery. The study was published
in the journal Pediatrics.
Fishman and his collaborators found that 8.4 percent of pediatric
appendectomy patients were later discovered not to have
appendicitis. The rate of misdiagnosis was about 50 percent higher
at hospitals doing the fewest pediatric appendectomies than at the
highest-volume hospitals.
The researchers propose improving these rates by studying the high-volume
centers to see what they do better and allow other hospitals to
learn from their experience. Fishman speculates that clinicians
who see higher volumes are more skilled in diagnosing appendicitis.
“There’s a difference between talking to and examining a young child
versus a cooperative adult,” says Fishman. “A frightened child may
not cooperate as well in an abdominal exam, and doing ultrasound
on a squirming child is different than doing ultrasound on an adult.”
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