Illnesses in children can be frustrating for the child, the parent, and the medical provider. When it comes to pediatric appendicitis, a misdiagnosis is common and can have significant consequences for your child. Given the difficulty children may have in expressing what hurts, where it hurts, and how it hurts, and the fact that appendicitis may not always present in the typical way, when is a misdiagnosis just part of the diagnosis and treatment process, and when is it medical negligence? As a parent, you may not be able to figure that out on your own.
An experienced New Mexico pediatric medical negligence attorney with Erin Marshall Law may be able to review your child’s medical records and help you understand whether you have a case for medical malpractice. Call (505) 218-9949 to schedule an appointment in our Albuquerque office and learn more about protecting your child’s rights if they experienced negligence when suffering from appendicitis.
What Is Pediatric Appendicitis?
The appendix is a small, finger-shaped organ in the lower right abdomen. Appendicitis is the inflammation of this organ, typically caused by infection, a tumor, or an obstruction of the appendix by hardened stool. For children ages five to eighteen, pediatric appendicitis is a common surgical emergency. Appendicitis is more common in boys than girls, and though it is most common between ages five and eighteen, it can occur at any age. The condition is generally unpreventable, though a healthy diet and regular exercise can prevent hardened stools. An appendectomy, or surgical removal of the appendix, is the standard treatment, but antibiotics may be used in rare instances. Misdiagnosis of appendicitis is common due to the symptoms and the methods used to diagnose it.
Appendicitis Symptoms
There are several symptoms of appendicitis, including:
- Lower right abdominal pain (may begin as a dull ache and gradually worsen, and is most often the first symptom)
- Tenderness and guarding when the abdomen is pressed
- Nausea
- Loss of appetite
- Vomiting
- Fever
- Diarrhea or constipation
While those are the typical symptoms, there are several atypical symptoms to be aware of. Younger children, particularly those under age three, often present with more atypical symptoms. The National Library of Medicine indicates these symptoms include:
- Irritability
- Grunting respiration
- Rhinitis or cough
- Pain and limping with restricted right hip mobility
- Diffuse or generalized abdominal pain
- Pain that radiates to the chest, back, or groin
- Pain that is not localized to the lower right abdomen
- Bloating
- Indigestion
- Chills
- Fatigue
- Urinary symptoms such as pain or frequency
Knowing the full spectrum of potential symptoms can help parents identify pediatric appendicitis.
Methods Used to Diagnose Appendicitis
If pain symptoms are present, the provider may have the child lie down on their back and perform tests such as extending the right leg or rotating a flexed leg. This can help determine both the severity and location of the pain. They will also do a general physical exam and check the child’s blood pressure, temperature, and heart rate.
The Taos Clinic for Children & Youth in Taos, New Mexico, indicates that other ways a provider may diagnose pediatric appendicitis include:
- Rectal exam
- Abdominal ultrasound
- Abdominal CT scan
- Exploratory laparotomy (a procedure using a camera and a small incision)
- Chest X-ray
- Complete blood count (CBC)
- Urinalysis and urine culture
- Pelvic exam (for female adolescents with abdominal pain)
An experienced medical professional can help with diagnosis.
Why Children Are Misdiagnosed So Frequently
Although adults are misdiagnosed more often than children, the reasons children tend to be misdiagnosed are different. Specifically, when looking at the misdiagnosis rate in younger children, which can reach nearly 100% in children under age two, there are very particular reasons behind it. These reasons include:
- Lack of Communication Skills: Particularly with children aged five and under, an inability to communicate at all or to communicate clearly can make it challenging to identify the problem. Even older children, including those in their teens, may struggle to identify all of their symptoms clearly due to pain or other symptoms. Children with other conditions that affect communication, such as mutism, deafness, or severe autism, may face communication challenges, too.
- Atypical Symptoms: Very young children often do not present with the typical appendicitis symptoms. This can cause misdiagnoses if the child presents with several symptoms that indicate another illness. They may also present with typical symptoms but in atypical ways, such as vomiting before pain.
- Symptoms May Mimic Other Conditions: Some pediatric appendicitis symptoms, such as vomiting, nausea, fever, diarrhea, and appetite loss, are common to many other illnesses, such as gastroenteritis (also known as the stomach flu), pneumonia, urinary tract infection (UTI), inflammatory bowel disease (IBD), sickle cell crisis, or diabetes ketoacidosis.
If the child has other chronic or complex conditions, those conditions may have similar symptoms, or the symptoms may mask those of appendicitis. Providers may misdiagnose the child with a “flare” of the other condition.
What Does It Mean to Misdiagnose Appendicitis?
Most of the time, when people talk about misdiagnosing appendicitis, they mean that the misdiagnosed child did have appendicitis, but was diagnosed with something else. However, this misdiagnosis can also go the other way. The child may be diagnosed with appendicitis, undergo surgery, and then the family finds out that they did not have appendicitis. The misdiagnosis in these cases often comes to light when the appendix is removed and examined. While some people may view this as acceptable, or even tell themselves it is a good thing to have it removed before it can cause a problem, it may still be medical negligence if the provider did not meet the expected standard of care.
What Are the Complications of Misdiagnosed Appendicitis in Children?
Several complications can arise due to misdiagnosed pediatric appendicitis. One study referenced by the National Library of Medicine indicates that up to 15% of children are seen twice or more in the emergency room before making the correct diagnosis. This allows more time for the appendicitis to worsen. Immediate and potentially life-threatening complications include the possible rupture of the appendix, which can lead to peritonitis (bacteria and pus from the infected appendix infect and inflame the lining of the abdominal cavity), and sepsis (infection spreading throughout the body, potentially leading to organ failure and death).
Other complications that can arise include a periappendicular abscess (a pocket of pus around the appendix from its rupture), more extensive surgeries, more extended hospital stays, and increased healthcare costs. Abdominal adhesions and chronic pain can be long-term complications that the child must deal with, and this can cause additional stress on the parents, particularly with small children who are dealing with pain but are unable to express that clearly.
What Can Be Mistaken for Appendicitis in Children?
Because many of the symptoms of appendicitis are also common to other conditions, children may be misdiagnosed if the medical provider bases their diagnosis solely on the child’s symptoms. Other conditions that can mimic appendicitis include:
- Gastroenteritis
- Constipation
- Urinary tract infection
- Mesenteric lymphadenitis
- Intussesception
- Ovarian torsion
- Pelvic inflammatory disease (most often in adolescent girls)
- Meckel’s diverticulum
- Crohn’s disease
- Ulcerative colitis
Parents should keep in mind that these shared symptoms mean that their child could be misdiagnosed with appendicitis when it is one of the other conditions, or they could be misdiagnosed with one of the different conditions when it is appendicitis. If medical negligence is suspected, parents may want to consult with an attorney at Erin Marshall Law to discuss their options.
Can You Sue for Misdiagnosis of Appendicitis?
When a parent discovers their child was misdiagnosed when they had pediatric appendicitis, they often wonder if they can file a lawsuit. The answer is yes, but only if the misdiagnosis rises to medical negligence. Before attempting to proceed with a medical malpractice lawsuit, parents should understand the components of malpractice, the potential compensation that may be recovered, and the statute of limitations.
Medical Malpractice Elements
Parents must prove four elements to establish a medical malpractice claim that may be successful. If any of the four elements cannot be proven, the claim will not succeed. However, even if a parent believes that they may be unable to establish one of the elements, they may want to consult with an attorney. A knowledgeable pediatric medical negligence attorney may be able to find the evidence required to prove the seemingly missing element.
The four elements are:
- Duty of Care: This requires proving a provider-patient relationship existed, which requires the provider to provide a standard of care that meets the expectations of that profession. In other words, they must give the same care that any other provider with a similar education, background, and geographic area would provide.
- Breach of Duty: This means proving that the provider breached their duty of care by failing to provide the appropriate standard of care, and that this failure resulted in the patient being harmed or injured.
- Causation: This element connects the provider’s breach of duty to the patient’s injuries. The provider’s breach must be the direct cause of the injuries.
- Damages: This element proves the child suffered actual harm or loss due to the injuries. This harm or loss includes medical bills, pain and suffering, or long-term disability.
These four facts can be connected to form a personal injury case.
Potential Compensation
Children do not have the same bills and financial obligations that adults do, but a misdiagnosis that rises to the level of medical negligence will result in compensable damages. These damages include past and future medical bills, lost wages, and any out-of-pocket costs associated with the negligence. If the child is old enough to have a part-time job, the lost wages may be their own, but they can also be the parents’ lost wages if the parent had to take time from work to care for the child.
Additional compensation includes pain and suffering, emotional distress, and loss of quality of life. In cases of extreme negligence, punitive damages may be awarded, but this generally only applies when the provider’s wrongdoing is intentional or they show a deliberate disregard for the child’s safety.
Statute of Limitations
New Mexico’s statute of limitations for medical malpractice is found in NMSA § 41-5-13. The standard statute of limitations in cases of malpractice is three years. However, minors and incapacitated individuals are provided an extended statute of limitations due to their inability to bring a claim themselves. This extension gives minors one year from and after the age of majority (eighteen in New Mexico) to bring their claim. In other words, minors have until their nineteenth birthday to file their own claim for medical negligence they experienced, even if that negligence occurred when they were an infant.
However, while minors have longer to file a claim, this does not mean that parents must wait and allow their child to file it when they are of age. Parents may still file the claim on the child’s behalf, which can be crucial if they need the compensation to pay the medical bills and other expenses associated with the malpractice. If parents intend to file the claim themselves, they must remember that the three-year statute of limitations binds them. If they miss that deadline, the child can still file once they turn eighteen, but the parents will not be able to file on their behalf before that.
How a Pediatric Medical Negligence Attorney May Benefit You
Children can sometimes be challenging to diagnose, particularly if they cannot communicate, hide symptoms, or present with atypical symptoms for a common condition. However, difficult to diagnose does not mean impossible, nor does it excuse negligence on the part of the provider. When your child has been misdiagnosed while suffering from pediatric appendicitis, an experienced New Mexico pediatric medical negligence attorney at Erin Marshall Law may be able to assist you in reviewing your child’s medical records to determine whether negligence played a role in your child’s misdiagnosis. If it did, we may also be able to assist you with gathering the necessary evidence, negotiating with insurance companies, or representing you in court if necessary. Call (505) 218-9949 to book an appointment and review your child’s legal rights and options.
