JMIR Publications

ABSTRACT

Background:

Acute appendicitis is a common disease process typically requiring surgery, yet the workflow linking diagnostic imaging to surgical consultation varies substantially across emergency departments. Delays between imaging completion and consult acquisition may prolong care and contribute to avoidable clinical and operational inefficiencies.

Objective:

This study quantified real-world consultation delays for patients with radiology-confirmed appendicitis and evaluated the cumulative time impact on emergency department workflow.

Methods:

We performed a retrospective observational study of emergency department encounters from January 1, 2020, through December 31, 2025, in which abdominal imaging was obtained to evaluate possible appendicitis. All radiology impressions were manually adjudicated and classified as positive, indeterminate, or negative. The primary timing measure was the interval from imaging completion to surgical consultation order. Mann–Whitney U tests compared delays across imaging modalities and age groups. Logistic regression assessed predictors of prolonged delay (>30 minutes).

Results:

Among 1,422 encounters, 566 were classified as radiology-positive appendicitis. Surgical teams evaluated 565 of these patients (99.8 percent), demonstrating that positive radiology findings nearly always resulted in surgical involvement regardless of documentation of a formal consult order. Among 524 radiology-positive encounters with complete timestamps in a predefined plausible window (−60 to +360 minutes), the median time from imaging completion to consultation was 30.8 minutes (IQR 17.8–48.5). Delays were longer for CT than ultrasound (median 34.9 vs 21.2 minutes; p < 0.0001). CT was associated with prolonged delay (OR 2.29; 95% CI 1.08–4.86), while age group was not. Across a typical year, cumulative waiting time totaled approximately 58 patient-hours.

Conclusions:

Radiology-confirmed appendicitis reliably triggered surgical evaluation, yet meaningful delays remained. Standardizing and automating consult activation for clear radiologic diagnoses may reduce avoidable workflow variation and improve the timeliness of surgical care.