Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study
Objective To derive and validate a tool that retrospectively identifies delayed diagnosis of appendicitis in administrative data with high accuracy.Design Cross-sectional study.Setting Five paediatric emergency departments (EDs).Participants 669 patients under 21 years old with possible delayed diag...
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BMJ Publishing Group
2023-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/2/e064852.full |
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| author | Andrea T Cruz Kenneth A Michelson Richard G Bachur Michael C Monuteaux Jonathan A Finkelstein Pradip P Chaudhari Joseph A Grubenhoff Arianna H Dart Scott D Reeves |
| author_facet | Andrea T Cruz Kenneth A Michelson Richard G Bachur Michael C Monuteaux Jonathan A Finkelstein Pradip P Chaudhari Joseph A Grubenhoff Arianna H Dart Scott D Reeves |
| author_sort | Andrea T Cruz |
| collection | DOAJ |
| description | Objective To derive and validate a tool that retrospectively identifies delayed diagnosis of appendicitis in administrative data with high accuracy.Design Cross-sectional study.Setting Five paediatric emergency departments (EDs).Participants 669 patients under 21 years old with possible delayed diagnosis of appendicitis, defined as two ED encounters within 7 days, the second with appendicitis.Outcome Delayed diagnosis was defined as appendicitis being present but not diagnosed at the first ED encounter based on standardised record review. The cohort was split into derivation (2/3) and validation (1/3) groups. We derived a prediction rule using logistic regression, with covariates including variables obtainable only from administrative data. The resulting trigger tool was applied to the validation group to determine area under the curve (AUC). Test characteristics were determined at two predicted probability thresholds.Results Delayed diagnosis occurred in 471 (70.4%) patients. The tool had an AUC of 0.892 (95% CI 0.858 to 0.925) in the derivation group and 0.859 (95% CI 0.806 to 0.912) in the validation group. The positive predictive value (PPV) for delay at a maximal accuracy threshold was 84.7% (95% CI 78.2% to 89.8%) and identified 87.3% of delayed cases. The PPV at a stricter threshold was 94.9% (95% CI 87.4% to 98.6%) and identified 46.8% of delayed cases.Conclusions This tool accurately identified delayed diagnosis of appendicitis. It may be used to screen for potential missed diagnoses or to specifically identify a cohort of children with delayed diagnosis. |
| format | Article |
| id | doaj-art-38590868ee8744fb8e4880dfbe973fb4 |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-38590868ee8744fb8e4880dfbe973fb42025-08-20T03:15:24ZengBMJ Publishing GroupBMJ Open2044-60552023-02-0113210.1136/bmjopen-2022-064852Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation studyAndrea T Cruz0Kenneth A Michelson1Richard G Bachur2Michael C Monuteaux3Jonathan A Finkelstein4Pradip P Chaudhari5Joseph A Grubenhoff6Arianna H Dart7Scott D Reeves8Department of Pediatrics, Baylor College of Medicine, Houston, TX, USADivision of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, USADivision of Emergency Medicine, Boston Children`s Hospital, Boston, MA, USADivision of Emergency Medicine, Boston Children`s Hospital, Boston, MA, USAKaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USAEmergency and Transport Medicine, Children`s Hospital Los Angeles, Los Angeles, California, USAPaediatric Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USADivision of Emergency Medicine, Boston Children`s Hospital, Boston, MA, USADivision of Pediatric Emergency Medicine, Cincinnati Children`s Hospital Medical Center, Cincinnati, OH, USAObjective To derive and validate a tool that retrospectively identifies delayed diagnosis of appendicitis in administrative data with high accuracy.Design Cross-sectional study.Setting Five paediatric emergency departments (EDs).Participants 669 patients under 21 years old with possible delayed diagnosis of appendicitis, defined as two ED encounters within 7 days, the second with appendicitis.Outcome Delayed diagnosis was defined as appendicitis being present but not diagnosed at the first ED encounter based on standardised record review. The cohort was split into derivation (2/3) and validation (1/3) groups. We derived a prediction rule using logistic regression, with covariates including variables obtainable only from administrative data. The resulting trigger tool was applied to the validation group to determine area under the curve (AUC). Test characteristics were determined at two predicted probability thresholds.Results Delayed diagnosis occurred in 471 (70.4%) patients. The tool had an AUC of 0.892 (95% CI 0.858 to 0.925) in the derivation group and 0.859 (95% CI 0.806 to 0.912) in the validation group. The positive predictive value (PPV) for delay at a maximal accuracy threshold was 84.7% (95% CI 78.2% to 89.8%) and identified 87.3% of delayed cases. The PPV at a stricter threshold was 94.9% (95% CI 87.4% to 98.6%) and identified 46.8% of delayed cases.Conclusions This tool accurately identified delayed diagnosis of appendicitis. It may be used to screen for potential missed diagnoses or to specifically identify a cohort of children with delayed diagnosis.https://bmjopen.bmj.com/content/13/2/e064852.full |
| spellingShingle | Andrea T Cruz Kenneth A Michelson Richard G Bachur Michael C Monuteaux Jonathan A Finkelstein Pradip P Chaudhari Joseph A Grubenhoff Arianna H Dart Scott D Reeves Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study BMJ Open |
| title | Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study |
| title_full | Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study |
| title_fullStr | Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study |
| title_full_unstemmed | Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study |
| title_short | Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study |
| title_sort | identification of delayed diagnosis of paediatric appendicitis in administrative data a multicentre retrospective validation study |
| url | https://bmjopen.bmj.com/content/13/2/e064852.full |
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