Patient gender does not influence the management or diagnosis of acute abdominal pain in the elderly, but affects outcome
Some 7.6 million people in the United States visit the emergency department (ED) each year for acute abdominal pain, making it the commonest reason for ED visits. Elderly men and women seen in the ED for this problem are managed similarly and have similar diagnoses in contrast to elderly patients seen for heart attack or stroke, according to a new study. However, elderly men have worse outcomes than elderly women.
In their study of 131 consecutive patients with abdominal pain seen at a major teaching hospital's ED, the researchers found similarity for the 52 men and 79 women in terms of mean age, ethnicity, primary language, insurance status, and coexisting illnesses at baseline. There were no significant differences in the median time to evaluation by a doctor (approximately 20 minutes for both sexes) or the median time at the ED for patients discharged to home (280 minutes for men, 319 minutes for women). Little difference was noted in the types of physical examination performed, laboratory tests conducted, imaging used, medication given (opioid analgesics, antibiotics), or frequency of surgical consultations.
A majority of both men (60 percent) and women (70 percent) were admitted to the hospital, mostly to nonsurgical services, for a median of 4 days for each group. The only notable difference was that 19 percent of all the men, but only 1 percent of all the women, died within 3 months of their ED visit, despite having similar predicted mortalities on the basis of their coexisting conditions. Data on the patients were abstracted from ED physician documentation, nursing notes, and medication records—as well as electronic and paper hospital records for those who were admitted. The study was funded in part by the Agency for Healthcare Research and Quality (HS11416).
More details are in "Does gender influence emergency department management and outcomes in geriatric abdominal pain?" by Rebekah L. Gardner, M.D., Richard Almeida, M.D., Judith H. Maselli, M.S.P.H., and others in the Journal of Emergency Medicine 39(3), pp. 275-281, 2010.
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