Copyright 2002 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2002
In Reply: In our study we found stable rates
of negative appendectomy over time, but found a higher rate of misdiagnosis
in women of reproductive age undergoing LA when compared with age- and sex-matched
patients undergoing open appendectomy. We agree with Dr Sauerland that there
is potential for selection bias in observational studies, and we cautioned
that this finding is likely the result of several factors.
Women of reproductive age, especially those with atypical presentations,
are more likely to be misdiagnosed and are more likely to undergo a laparoscopic
procedure compared with patients with more straightforward clinical presentations.
It is therefore expected that patients undergoing LA have a higher rate of
misdiagnosis compared with both the general population and with age- and sex-matched
patients in whom the presentation is more classic. Furthermore, unlike the
formalized trial protocols cited by Sauerland, in general practice there is
no agreement regarding the appropriate management of a normal-appearing appendix
found during a laparoscopic procedure. Leaving the normal-appearing appendix
in situ has been challenged by a study suggesting that a surgeon's inspection
of a "normal" appendix offers only a 28% negative predictive value.1 An additional factor in understanding the high
rate of misdiagnosis with LA is the issue of miscoding. The code for an incidental
LA is most likely applied when the appendix is removed incidental to another
procedure. It is less clear, however, if an LA would be considered incidental
if other nonoperative pathology was identified during the diagnostic component
of the LA. We were unable to assess the frequency of this occurrence in the
Flum DR. Misdiagnosis of Appendicitis—Reply. JAMA. 2002;287(1):43–44. doi:10.1001/jama.287.1.40
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