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Appendicitis is one of the most common surgical issues in hospital Accident and Emergency departments in the UK. But patients often suffer due to delayed diagnosis of appendicitis.
According to the British Medical Journal, it accounts for around 40,000 emergency admissions per year in England. And yet, appendicitis is often missed or misdiagnosed, with patients dismissed by GPs or discharged without a correct diagnosis.
Appendicitis. One of the few medical diagnoses that most people will have heard about during their lifetime.
The NHS website tells us that the main symptoms are pain that typically starts in the middle of your abdomen that may come and go, nausea and vomiting, loss of appetite, constipation or diarrhoea and a high temperature.
If you compare these symptoms with the symptoms of gastroenteritis, including pain in the abdomen, nausea and vomiting, loss of appetite, diarrhoea, occasional muscle aches, and low-grade fever, you can see the striking similarities between the two.
However, the treatment for both is strikingly different – gastroenteritis requires rest, hydration, paracetamol. On the other hand, appendicitis will almost certainly require surgery under a general anaesthetic.
It is essential doctors get the diagnosis right. But to further confuse matters, the main symptoms of appendicitis are only present in around 50% of patients.
Unfortunately, a delay in diagnosing appendicitis or a misdiagnosis can lead to severe, life-threatening complications. These include a burst appendix (perforation), abscess formation, peritonitis, sepsis, intra-abdominal adhesions, and bowel obstruction. In some tragic cases, delayed diagnosis of appendicitis can be fatal.
Getting an accurate appendicitis diagnosis
The first port of call for most people when they are having appendicitis symptoms is their GP surgery.
GPs have at their disposal a set of NICE (National Institute for Health and Care Excellence) Guidelines for diagnosing appendicitis. It states that appendicitis should be suspected if there is:
- Periumbilical or epigastric pain that worsens and moves to the right lower quadrant over 24–48 hours. It is typically aggravated by movement
- Low-grade fever, general malaise, and anorexia (unusual loss of appetite)
- Nausea, vomiting, and sometimes constipation or diarrhoea
- Tenderness in the right lower quadrant on abdominal examination, which may be worse on coughing or hopping in children
- Abdominal distension (swelling), guarding, rebound tenderness or percussion tenderness, or absent bowel sounds (which may all suggest peritonitis)
- A palpable abdominal mass (which may indicate an appendix mass or abscess)
Any of the above appendicitis symptoms require emergency admission to the hospital for specialist assessment and management.
As can be seen, the likely diagnosis depends significantly upon a physical examination of the patient. Unfortunately, with the onset of the COVID-19 pandemic, physical appointments to see GPs became difficult for many people to obtain, with telephone or video consultations becoming the norm instead.
While most people are happy for an initial consultation by telephone to take place, it is usually hoped that a GP will agree to see them or refer them to Accident & Emergency if there are red flag symptoms.
But when this does not happen, then what? GPs are usually the gatekeepers to the NHS. If this gate remains closed following a telephone consultation (or even several consultations), how can a patient know if something is seriously wrong?
Are the potentially fatal complications of a ruptured appendix a risk worth taking when deciding whether to offer a patient a face-to-face appointment?
The latest data compiled by the Royal College of General Practitioners shows that only half of all appointments are now face-to-face, despite Government guidance.
NHS England says that GP practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary, such as a patient displaying COVID-19 symptoms.
However, many patients are reporting problems getting physical appointments with their GPs – sometimes with life-threatening consequences.
A recent newspaper article told the story of a woman who almost died from a burst appendix after three GPs refused to see her face-to-face due to COVID-19 lockdown concerns.
The first GP she spoke to over the phone wrongly diagnosed her with viral gastroenteritis. Following two further GP calls, she was finally advised to go straight to A&E by an acute nurse from the NHS 111 service.
Unfortunately, this is a growing problem and our specialist medical negligence team is seeing an increase in diagnosis delays due to COVID-19.
Please book your free initial consultation with our medical negligence solicitors
If you or a loved one has suffered from appendicitis complications due to being refused a face-to-face appointment with your GP, or if your appendicitis diagnosis was delayed, contact our medical negligence solicitors for a free, confidential chat.