Abdominal Pain in Geriatric Emergency Patients: Variables Associated with Adverse Outcomes

Abstract

Abstract. Objective: To determine the diagnoses and outcomes of geriatric patients with abdominal pain, and to identify variables associated with adverse outcomes. Methods: Geriatric emergency patients (aged 65 years and older) with a complaint of abdominal pain were participants in this longitudinal case series. Eligible patients were followed by telephone contact and chart review, to determine outcomes and final diagnoses. Results: Of 380 eligible patients, follow-up information was available for 375 (97%), for the two months following the ED visit. Final diagnoses included infection (19.2%), mechanical-obstructive disorders (15.7%), ulcershypersecretory states (7.7%), urinary tract disease (7.7%), malignancy (7.2%), and others. Although 5.3% of the patients died (related to presenting condition), most (61.3%) patients ultimately recovered. Surgical intervention was required for 22.1% of the patients. Variables associated with adverse outcomes (death, and need for surgical intervention) included hypotension, abnormalities on abdominal radiography, leukocytosis. ahnormal bowel sounds, and advanced age. Most physical examination findings were not helpful in identifying patients with adverse outcomes. This study demonstrated a higher incidence of malignancy (7.2%) and a lower incidence of disease necessitating surgical intervention (22.1%) than previously reported. Conclusions: The majority of geriatric emergency patients with abdominal pain have significant disease necessitating hospital admission. Morbidity and mortality among these patients are high, and specific variables are strongly associated with death and the need for surgical intervention. Absence of these variables does not preclude significant disease. Physical examination findings cannot reliably predict or exclude significant disease. These patients should be strongly considered for hospital admission, particularly when fever, hypotension, leukocytosis, or abnormal bowel sounds are present. Key words: abdominal pain; geriatrics; elder; adverse outcomes; predictors; diagnosis. ACADEMIC EMERGENCY MEDICINE 1998; 511163-1168 ERIATRIC persons (aged 65 years and older) G represent the fastest growing segment of the population, and currently comprise 12% of the U.S. population. The diseases of geriatric emergency patients have posed significant diagnostic and management challenges, in part due to patients' tendency to delay seeking medical care, the atypical presentations, presence of coexisting diseases, atypical physical examination findings, atypical laboratory values, and higher morbidity and mortality.l-I6 Previous studies have demonstrated a diagnostic accuracy of only 40% to 65% in geriatric patients with abdominal ~a i n . * -~.~, I~We undertook this investigation to ascertain fi- nal diagnoses and outcomes of geriatric ED patients with abdominal pain. We also wanted to determine which routinely available clinical variables are associated with higher likelihood of the need for surgical intervention, and death within a two-month period among this pa...

Abdominal Computed Tomography Utilization and 30-day Revisitation in Emergency Department Patients Presenting With Abdominal Pain

“…8,9 Elevated or not recorded triage heart rate, low sodium levels, low hemoglobin, and increasing triage pain values were also found to be positively associated with revisits. The fact that an elevated WBC count is not associated with revisits may seem counterintuitive, as patients with elevated WBC count would be expected to be more likely to have serious illness; 27 however, multiple studies have shown that while an overall marker of disease severity, leukocytosis is not particularly sensitive or specific in identifying particular etiologies of abdominal pain. 28,29 The mechanism for the association with decreased revisits is unclear; perhaps as these patients had obvious "red flags" by laboratory evaluation, the threshold for discharge was higher.…”

Impact of CT in elderly patients presenting to the emergency department with acute abdominal pain

“…CT utilization in the ED has increased at an annual rate of 14%, from 2.7 million exams in 1995 to 16.2 million exams in 2007 [19]. In parallel, the Emergency Medicine literature stresses the importance of early, liberal imaging in the elderly population and advocates a low threshold for hospital admission in elderly patients with undifferentiated abdominal pain [20].…”

Acute abdominal pain: emergency diagnosis and treatment (Part II)

“…L'ipotesi di NSAP è avvalorata da una non eclatante dolorabilità alla palpazione e dall'assenza di peritonismo, mentre una lieve leucocitosi non la esclude, essendo una conta dei globuli bianchi superiore a 10.500/µl presente nel 28% di tali pazienti 4 e risultando inoltre poco elevata la specificità della leucocitosi anche per le patologie che entrano in diagnosi differenziale. Il NSAP è comunque una diagnosi d'esclusione e occorre sottolineare che nell'anziano, in cui più alta è la percentuale di diagnosi errate ed elevata l'incidenza di malattie pericolose e potenzialmente chirurgiche, con probabilità accresciuta in assenza di anamnestici episodi di dolore simile, l'esame fisico ha dimostrato scarsa sensibilità e specificità per tale diagnosi 5 . Nell'età geriatrica pertanto, in alternativa o a completamento dell'osservazione, trova indicazione l'esecuzione in acuto di una TC addome, in grado di escludere con accuratezza le più pericolose patologie chirurgiche.…”