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Up to 25% of elderly patients with appendicitis are initially sent home from the ED, an indication of the high misdiagnosis rate for appendicitis in the elderly population. Why are elderly patients so often misdiagnosed when they have appendicitis? The answer is simple....they present very atypically.
- The classic migratory pattern (periumbilical pain that migrates to the RLQ) is absent in > 50%
- Nasea, vomiting, and anorexia are each absent in > 50%
- Fever is absent in up to 50%
- Guarding and rebound are absent in 50%
- The WBC is normal in up to 45%
- Up to 15% have pyuria or bacteriuria, leading to misdiagnoses of UTI
Expect the atypical in elderly patients!