One-Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
1 January 2019
,
Page e44
https://doi.org/10.22037/aaem.v7i1.350
Abstract
Introduction: About one third of patients referring to emergency department (ED) with abdominal pain, are discharged without a definite diagnosis. This study aimed to investigate the one-month outcome of patients with unspecified abdominal pain.
Methods: This cohort study was conducted on subjects who were evaluated in ED with unspecified abdominal pain and were referred to the gastroenterology clinic and followed for one month. Finally, they were divided into two groups of cases with clear cause of abdominal pain and unclear cause of abdominal pain and patients’ characteristics were compared between the groups.
Results: 150 cases with the mean age of 40.68 ± 18.34 years were studied (53.3% female). After one month, 67 (44.7%) patients still complained of abdominal pain. A definitive cause of abdominal pain was established in 88 (58.7%) cases. There was not any significant difference between groups regarding, sex distribution (p = 012), duration of pain (p = 0.11), history of previous similar pain (p = 0.136), pain radiation (p = 0.737), length of hospital stay (p = 0.51), and presence of anorexia (p = 0.09), nausea and vomiting (p= 0.50), fever (p = 1.0), diarrhea (p = 0.23), and constipation (p = 0.07). There was a significant difference between the groups regarding location of pain (p = 0.017), age (p = 0.001) and history of comorbid diseases (p = 0.046). The predictive factors of finding a clear cause for abdominal pain in one-month follow-up, were leukocytosis (OR: 5.92 (95% CI: 2.62 – 13.39); p < 0.001), age (OR: 2.78 (95% CI: 1.15 – 6.71); p = 0.023), and outpatient follow-up (OR: 1.04 (95% CI: 1.02 – 1.07); p < 0.001).
Conclusion: Approximately, 40% of patients who were discharged with unspecified abdominal pain did not receive a clear diagnosis after one month of follow-up. Older age, leucocytosis in initial evaluations, and outpatient follow-up increased the probability of finding a clear cause for abdominal pain in the mentioned cases.
- Abdominal pain
- patient discharge
- follow-up studies
- emergency service
- hospital
How to Cite
References
Gans SL, Pols MA, Stoker J, Boermeester MA, expert steering g. Guideline for the diagnostic pathway in patients with acute abdominal pain. Digestive surgery. 2015;32(1):23-31.
Hastings RS, Powers RD. Abdominal pain in the ED: a 35 year retrospective. The American journal of emergency medicine. 2011;29(7):711-6.
Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. National health statistics reports. 2010(26):1-31.
Cooper JG, Hammond-Jones D, O'Neill E, Patel R, Murphy R, Clamp SE, et al. The Clinical Decision Unit has a role to play in the management of acute undifferentiated abdominal pain. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2012;19(5):323-8.
Caporale N, Morselli-Labate AM, Nardi E, Cogliandro R, Cavazza M, Stanghellini V. Acute abdominal pain in the emergency department of a university hospital in Italy. United European gastroenterology journal. 2016;4(2):297-304.
Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F, et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Annals of translational medicine. 2016;4(19):362.
Medford-Davis L, Park E, Shlamovitz G, Suliburk J, Meyer AN, Singh H. Diagnostic errors related to acute abdominal pain in the emergency department. Emergency medicine journal : EMJ. 2016;33(4):253-9.
Kachalia A, Gandhi TK, Puopolo AL, Yoon C, Thomas EJ, Griffey R, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Annals of emergency medicine. 2007;49(2):196-205.
Agresta F, Ansaloni L, Catena F, Verza LA, Prando D. Acute appendicitis: position paper, WSES, 2013. World journal of emergency surgery : WJES. 2014;9(1):26.
Decadt B, Sussman L, Lewis MP, Secker A, Cohen L, Rogers C, et al. Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain. The British journal of surgery. 1999;86(11):1383-6.
Banz VM, Sperisen O, de Moya M, Zimmermann H, Candinas D, Mougiakakou SG, et al. A 5-year follow up of patients discharged with non-specific abdominal pain: out of sight, out of mind? Internal medicine journal. 2012;42(4):395-401.
Lin WC, Lin CH. Multidetector computed tomography in the evaluation of pediatric acute abdominal pain in the emergency department. BioMedicine. 2016;6(2):10.
Coskun A, Yavasoglu I, Sargin G, Ok IM, Bircan M, Avcil M, et al. The role of mean platelet volume in patients with non-specific abdominal pain in an emergency department. Przeglad gastroenterologiczny. 2015;10(3):156-9.
Pappas A, Toutouni H, Gourgiotis S, Seretis C, Koukoutsis I, Chrysikos I, et al. Comparative approach to non-traumatic acute abdominal pain between elderly and non-elderly in the emergency department: a study in rural Greece. Journal of clinical medicine research. 2013;5(4):300-4.
Espinoza R, Balbontin P, Feuerhake S, Pinera C. [Acute abdomen in the elderly]. Revista medica de Chile. 2004;132(12):1505-12.
Esses D, Birnbaum A, Bijur P, Shah S, Gleyzer A, Gallagher EJ. Ability of CT to alter decision making in elderly patients with acute abdominal pain. The American journal of emergency medicine. 2004;22(4):270-2.
Marco CA, Schoenfeld CN, Keyl PM, Menkes ED, Doehring MC. Abdominal pain in geriatric emergency patients: variables associated with adverse outcomes. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 1998;5(12):1163-8.
Forouzanfar MM, Hatamabadi HR, Hashemi B, Majidi A, Baratloo A, Shahrami A, et al. Outcome of nonspecific abdominal pain in the discharged patients from the emergency department. Journal of Gorgan University of Medical Sciences. 2014;16(2):62-8.
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