Can Surgical Registrars Accurately Identify the Urgent from the Non-Urgent Patient Presenting with Acute Abdominal Pain?

2019 ◽  
Vol 60 (1-2) ◽  
pp. 24-30 ◽  
Author(s):  
Kirsten J. de Burlet ◽  
Anna B.M. Lam ◽  
Simon J. Harper ◽  
Peter D. Larsen ◽  
Elizabeth R. Dennett
Keyword(s):  
Abdominal Pain ◽  
Patient Outcomes ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Initial Assessment ◽  
Wide Range ◽  
Urgent Patient ◽  
Hospital Resources ◽  
A Prospective Study ◽  
Diagnostic Skill

Background: Acute abdominal pain is a common surgical presentation with a wide range of causes. Differentiating urgent patients from non-urgent patients is important to optimise patient outcomes and the use of hospital resources. The aim of this study was to determine how accurately urgent and non-urgent patients presenting with abdominal pain can be identified. Methods: A prospective study of consecutive patients admitted with abdominal pain was undertaken. Urgent patients were classified as requiring treatment (theatre, intensive care unit, endoscopy, or radiologic drainage) within 24 h. Differentiation between urgent and non-urgent was made on the basis of the initial assessment prior to the use of advanced imaging. Outcomes were compared to a final classification based on final diagnosis as adjudicated by an expert panel. Results: Of the 301 patients included, 93 (30.9%) were deemed urgent based on initial assessment, compared to 83 (27.6%) on final diagnosis. Overall sensitivity for recognising urgent patients was 74.7% and specificity 89.9%, and overall accuracy was higher for senior registrars compared to junior registrars (p = 0.015). Urgent patients more often looked unwell or had peritonism on examination (39.8 vs. 17.4% and 56.6 vs. 14.7%, respectively, p < 0.001 for both). Conclusions: Registrars can accurately differentiate urgent from non-urgent patients with acute abdominal pain in the majority of cases. Accuracy was higher amongst senior registrars. The “end-of-the-bed-o-gram” and clinical examination are the most important features used for making this differentiation. This demonstrates that there is no substitute for exposure to acute presentations to improve a trainee’s diagnostic skill.

Abdominal Pain

2014 ◽  
Vol 25 (3) ◽  
pp. 266-278 ◽  
Author(s):  
Helen F. Brown ◽  
Lynn Kelso
Keyword(s):  
Abdominal Pain ◽  
Patient Outcomes ◽  
Systematic Approach ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Multiple Organ ◽  
Appropriate Treatment ◽  
Organ Systems ◽  
Life Threatening ◽  
Cardinal Symptom

Acute abdominal pain represents the cardinal symptom of a large number of intra-abdominal pathologies. Because of multiple organ systems, varied pathology from life threatening to benign, and differences in presentation related to sex and age, identifying a final diagnosis is a challenge. The clinician’s goal for patients with acute abdominal pain is to rapidly identify whether the underlying cause requires an urgent or immediate surgical intervention. By developing a systematic approach to evaluating patients with abdominal pain, clinicians can generate a differential diagnosis to ensure appropriate treatment and improved patient outcomes. The purpose of this article is to provide clinicians with a framework for evaluating the complaint of acute abdominal pain and recognizing patients who require expedited evaluation.

Bayesian Diagnostic Probabilities without Assuming Independence of Symptoms

1991 ◽  
Vol 30 (01) ◽  
pp. 15-22 ◽  
Author(s):  
A. Gammerman ◽  
A. R. Thatcher
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Bayes Theorem ◽  
Bayes Method ◽  
Hospital Records ◽  
Computer Diagnosis ◽  
Bayes Model ◽  
Chi Squared ◽  
Past Data

The paper describes an application of Bayes’ Theorem to the problem of estimating from past data the probabilities that patients have certain diseases, given their symptoms. The data consist of hospital records of patients who suffered acute abdominal pain. For each patient the records showed a large number of symptoms and the final diagnosis, to one of nine diseases or diagnostic groups. Most current methods of computer diagnosis use the “Simple Bayes” model in which the symptoms are assumed to be independent, but the present paper does not make this assumption. Those symptoms (or lack of symptoms) which are most relevant to the diagnosis of each disease are identified by a sequence of chi-squared tests. The computer diagnoses obtained as a result of the implementation of this approach are compared with those given by the “Simple Bayes” method, by the method of classification trees (CART), and also with the preliminary and final diagnoses made by physicians.

scholarly journals Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

2018 ◽  
Vol 27 (2) ◽  
pp. 79-86
Author(s):  
Nalan Kozaci ◽  
Mustafa Avci ◽  
Gul Tulubas ◽  
Ertan Ararat ◽  
Omer Faruk Karakoyun ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Physician ◽  
Gold Standard ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Free Fluid ◽  
Emergency Physicians ◽  
Abdominal Ultrasonography

Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

Clinical spectrum of acute abdominal pain in Turkish pediatric patients: A prospective study

2004 ◽  
Vol 46 (3) ◽  
pp. 325-329 ◽  
Author(s):  
Tulay Erkan ◽  
Halit Cam ◽  
Hilda Cerci Ozkan ◽  
Evrim Kiray ◽  
Ethem Erginoz ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Prospective Study ◽  
Pediatric Patients ◽  
Acute Abdominal Pain ◽  
Clinical Spectrum ◽  
A Prospective Study

scholarly journals Delayed Bleeding and Pelvic Haematoma after Low-Energy Osteoporotic Pubic Rami Fracture in a Warfarin Patient: An Unusual Cause of Abdominal Pain

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Andrea Sandri ◽  
Dario Regis ◽  
Nicola Bizzotto
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
The Elderly ◽  
Fresh Frozen Plasma ◽  
Low Energy ◽  
Haemodynamic Monitoring ◽  
Delayed Bleeding ◽  
Pubic Rami ◽  
Wide Range ◽  
Pain In The Elderly

Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described.Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED) with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma.Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with “benign” osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications.

scholarly journals CT in the diagnosis of nontraumatic acute abdominal pain: clinical cases

2019 ◽  
pp. 82-89
Author(s):  
A. V. Arablinskii ◽  
Yu. A. Magdebura
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
Acute Abdominal Pain ◽  
Abdominal Cavity ◽  
Selection Criterion ◽  
Final Diagnosis ◽  
Diagnostic Process ◽  
Medical File ◽  
Moscow City ◽  
Ct Data

Acute abdominal pain (AAP) is a clinical symptom complex that develops with injuries and acute surgical diseases of the abdominal organs. This condition is one of the most frequent causes of admission of patients to the hospital through the ambulance. Patients with AAP consist of a large and heterogeneous group at the same time due to the etiology and many variations of the clinical picture of this condition. The article presents the results of CT scan of the abdominal cavity and small pelvis in 5 patients with AAP admitted to the S.P. Botkin Moscow City Clinical Hospital emergency department during 2017–2018, without indication of the possible traumatic nature of the pathology. All patients underwent a primary surgeon examination and first-line medical imaging methods such as plane radiography and ultrasound. The selection criterion for inclusion in the search was the need for CT due to the lack of data obtained for diagnosis. Subsequently, the findings of the CT scan were compared with the final diagnosis in the electronic medical file of the patient concerned, to assess the contribution of CT data to the diagnostic process. In a group of 5 patients included in the study, the results of CT were the decisive step in the diagnostic process in 100% of cases. Therefore, the study emphasizes the importance of using CT in patients with AAP. Using this method allows you to complete a diagnostic search as soon as possible from the time the patient enters the hospital, to begin timely treatment.

Manifestations of Acute Appendicitis: A Prospective Study on Acute Abdominal Pain

2013 ◽  
Vol 30 (3) ◽  
pp. 198-206 ◽  
Author(s):  
H. Laurell ◽  
L.-E. Hansson ◽  
U. Gunnarsson
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Prospective Study ◽  
Acute Abdominal Pain ◽  
A Prospective Study

scholarly journals EP.FRI.376 Early Routine CT Scans for All Surgical Admissions for Abdominal Pain May Improve Patient Outcomes

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Samantha Quah ◽  
Hock Ping Cheah ◽  
Kenneth Wong
Keyword(s):  
Abdominal Pain ◽  
Patient Outcomes ◽  
Acute Abdominal Pain ◽  
Correct Diagnosis ◽  
Diagnostic Error ◽  
Error Rates ◽  
Accurate Diagnosis ◽  
Diagnostic Challenge ◽  
Radiology Report ◽  
Imaging Results

Abstract Aim Acute abdominal pain remains a diagnostic challenge in the Emergency Department (ED) as pathologies can involve various surgical craft groups. Computed tomography (CT) enables accurate diagnosis of abdominal pathologies. However, with pressures on ED such as the “4 hour rule” established by the Australian NSW Health Emergency Performance Plan, there may be resistance or omission of early CT in ED. We hypothesise that early, routine CT in adult patients presenting with acute abdominal pain requiring hospital admission improves patient outcomes by increasing diagnostic and referral accuracy. This study compares the proportion of correct ED diagnosis of abdominal pain presentations with and without formal imaging reports. Methods Data from 118 patients presenting with abdominal pain are collected prospectively in a regional hospital and analysed. Patient demographics, imaging results, initial ED diagnosis and final discharge diagnosis are further examined. Results Out of the 118 patients who had abdominal pain, 32 patients obtained complete imaging with a radiology report whilst 86 patients either did not have any imaging performed or was referred to a general surgical unit prior to obtaining a formal report. Among the patients who had imaging reported, 78% (n = 25/32) had the correct diagnosis, whilst those without a radiology report had a 52% (n = 45/86) diagnostic accuracy. This demonstrates an improved accuracy of diagnosis or reduced error rate of 26% when a scan report is available (p = 0.01). Conclusion Early, routine CT with formal reporting significantly reduces diagnostic error rates and increases accurate referral. This allows accurate diagnosis and improves patient outcomes.

scholarly journals Impact of Clinical Experience and Diagnostic Performance in Patients with Acute Abdominal Pain

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Helena Laurell ◽  
Lars-Erik Hansson ◽  
Ulf Gunnarsson
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diagnostic Performance ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Emergency Department Physician ◽  
Time Of Arrival ◽  
Base Line ◽  
Preliminary Diagnosis ◽  
One Year

Background.The aims were to evaluate the importance of the formal competence of the emergency department physician, the patient’s time of arrival at the emergency department, and the use of a structured schedule for investigation of patients with acute abdominal pain.Methods.Patients attending the Mora Hospital with acute abdominal pain from 1997 to 2000 were registered prospectively according to a structured schedule. Registration included history, symptoms, signs, preliminary diagnosis, surgery and final diagnosis after at least one year.  Results.3073 acute abdominal pain patients were included. The preliminary diagnosis, as compared with the final diagnosis, was correct in 54%(n=1659). Previously, during 1996, a base-line registration of 790 patients had a 58% correct diagnoses  (n=458). A majority of the patients (n=2699; 88%) were managed by nonspecialists. The proportion of correct diagnoses was 54%(n=759)for pre-registrar house officers and 55%(n=443)for senior house officers. Diagnostic performance at the emergency department was independent of patient’s time of arrival.Conclusions.A structured schedule for investigation did not improve the diagnostic precision at the emergency department in patients with acute abdominal pain. The diagnostic performance was independent of the formal competence of the physician and the patient's time of arrival.

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