Is female sex associated with ED delays to diagnosis of appendicitis in the computed tomography era?

Abstract

Background Historically, females had delays to definitive diagnosis of appendicitis when compared to males. In this current millennium, appendicitis is now most commonly diagnosed by computed tomography (CT) in the emergency department (ED) rather than at surgery. Objective The aim of the study was to assess if female gender is still associated with delays to diagnosis of appendicitis in the CT era. Methods A retrospective cohort analysis of adult patients with appendicitis at a university teaching hospital ED was conducted. Inclusion criteria was age of more than 18 years and an International Classification of Diseases, Ninth Revision (ICD-9), diagnosis of appendicitis. Patients were excluded from analysis if they were pregnant, no CT scan was obtained in the ED, or had incomplete outcome data. Results One hundred thirty-seven patients met inclusion criteria; 65 female, 72 males. Time from triage to CT order was 138 minutes in females and 95 minutes in males ( P = .0012). Time from initial physician evaluation to CT order was 45 minutes in females and 28 minutes in males ( P = .0012). Nonclassic symptoms were more common in females and pelvic evaluation did not delay the CT order. Conclusion Female gender is still associated with delays to CT acquisition and diagnosis of appendicitis.