Hulya ALADAG
Eurasian Journal of Critical Care - 2026;8(2):85-89
Background: Acute lower abdominal pain is a common reason for emergency department presentation, and differentiating surgical from gynecological conditions in female patients remains a major diagnostic challenge because of substantial clinical overlap. This study aimed to evaluate the demographic, clinical, physical examination, and laboratory characteristics of female patients presenting with acute lower abdominal pain and to identify independent clinical predictors that may facilitate the differential diagnosis. Methods: This retrospective observational study included 300 female patients presenting to the emergency department with acute lower abdominal pain between January 2019 and December 2023. Patients were classified into acute appendicitis, gynecological pathology, or nonspecific abdominal pain according to their final diagnosis. Demographic characteristics, clinical symptoms, physical examination findings, and laboratory results were compared among groups. Binary logistic regression was performed to identify independent predictors of appendicitis among patients with appendicitis and gynecological pathology. Model discrimination was assessed using receiver operating characteristic (ROC) analysis. Results: Of the 300 patients, 99 (33.0%) were diagnosed with acute appendicitis, 81 (27.0%) with gynecological pathology, and 120 (40.0%) with nonspecific abdominal pain. Patients with appendicitis were significantly younger than those in the other groups (p<0.001). Rebound tenderness, muscular defense, anorexia, fever, leukocytosis, and positive Psoas and Rovsing signs were significantly more common in appendicitis, whereas nausea and normal urine microscopy did not differ significantly between appendicitis and gynecological disorders. Multivariable logistic regression identified younger age, leukocytosis, muscular defense, Rovsing sign, and fever as independent predictors of appendicitis. The final diagnostic model demonstrated excellent performance, with an area under the ROC curve of 0.98 (95% CI 0.97-1.00), a sensitivity of 93.9%, and a specificity of 96.3%. Conclusion: Female patients with acute lower abdominal pain exhibit considerable clinical overlap between appendicitis and gynecological disorders. Nevertheless, younger age, leukocytosis, muscular defense, Rovsing sign, and fever independently distinguish acute appendicitis. The proposed multivariable model demonstrated excellent diagnostic accuracy but requires internal and external validation before routine clinical implementation
