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Avoiding needless appendectomies
Study: Busy hospitals have something to teach

ospitals 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.”