Whether a patient is seen in a large teaching hospital, small community hospital or prison system, an infected appendix has the potential to be a major abdominal issue, with increased risk of litigation against an emergency physician[1].

Appendicitis is hard to diagnose in that there is not one presenting symptom or finding on physical exam. Most patients arrive to the ER with vague abdominal discomfort and eventual right lower quadrant pain. Unfortunately the differential diagnosis can mimic other abdominal emergencies (pancreatitis, intestinal obstruction and kidney infection)[2], thus increasing the odds of missed diagnosis.

The traditional symptoms of colicky pain in the central/ right lower abdomen are only seen in approximately 50% of patients[3]. Patients can have loss of appetite, nausea and vomiting, but not everyone. Many people can have a low-grade fever or change in white blood cells, but not everyone. Unfortunately, many patients might not be accurately diagnosed until after the appendix has ruptured, with the increased risk of peritonitis. The MD then needs to pay careful attention to the patient’s history, perform a thorough physical examination and obtain lab studies. If the findings then are suggestive of appendicitis, an abdominal CT is ordered for further diagnostic clarification.

Before an attorney decides to litigate a case of failure to diagnose, they need a thorough review of the medical records. A legal nurse can provide the necessary analysis and deliver a report that includes the possible strength and weaknesses. The attorney then can decide to proceed forward, after being fully informed. 

An attorney needs to be empowered, to determine their best course of action. The nurses from Integrity Legal Nurse Consulting, PDX can then help fulfill that need, as the important link between client and trial.

  1. http://www.scirp.org/journal/PaperInformation.aspx?PaperID=6873#.VNMRQyn6Tao
  2. http://emedicine.medscape.com/article/773895-differential
  3. http://www.academia.edu/5362508/Clinical_Presentation_of_Acute_Appendicitis_Clinical_Signs_Laboratory_Findings_Clinical_Scores_Alvarado_Score_and_Derivate_Scores