Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes

Abstract

Abdominal pain (AP) is a common reason for presentation to an emergency department (ED). With this prospective, observational all-comer study, we aimed to answer three questions: Which diagnoses are most often missed? What is the incidence of extra-abdominal causes? What is the prognosis of abdominal pain in a tertiary urban European ED? Participants were systematically interviewed for the presence of 35 predefined symptoms. For all patients with abdominal pain, the index visit diagnoses were recorded. Related representation was defined as any representation, investigation, or surgery related to the index visit (open time frame). If a diagnosis changed between index visit and representation, it was classified as missed diagnosis. Among 3960 screened presentations, 480 (12.1%) were due to AP. Among 63 (13.1%) related representations, the most prevalent causes were cholelithiasis, gastroenteritis, and urinary retention. A missed diagnosis was attributed to 27 (5.6%) presentations. Extra-abdominal causes were identified in 162 (43%) presentations. Thirty-day mortality was comparable to that of all other ED patients (2.2% vs. 2.1%). Patients with abdominal pain had a low risk of representation, and the majority of representations due to missed diagnoses were of benign origin. The high incidence of extra-abdominal causes is noteworthy, as this may induce change to differential diagnosis of abdominal pain.

Causes of Acute Abdominal Pain in Geriatrics: A Review

“…Additionally, increased cholesterol and phospholipid content of the bile causes gallbladder stones and increased biliary tract diameter results in biliary diseases [22]. Among the studies included in our results; three studies reported biliary disorder as the first cause of abdominal pain in elderly [11,13,15]. The mortality rate of elderly patients diagnosed with cholecystitis is approximately 10%.…”

Prehospital assessment of patients with abdominal pain triaged to self-care at home: an observation study

“…The population in the current study is relatively young compared to patients with abdominal pain who are typically admitted to EDs [ 22 ]. This is a positive finding, as it probably means that most elderly patients are transported to hospitals.…”

The NSW Pathology Atlas of Variation: Part I—Identifying Emergency Departments With Outlying Laboratory Test–Ordering Practices

“…29 Acute abdominal pain has been identified as one of the top 5 reasons patients present to an ED in the United States, [30][31][32][33] with studies between 2007 and 2019 reporting abdominal pain in ED cohorts representing between 6.5% 34 and 11.88% 35 in the United States 30,33 and 5.76% 36 to 20% 37 internationally. [38][39][40] As a presenting complaint, abdominal pain has been described as a diagnostic challenge 34,41,42 for ED clinicians, with an array of potential causes ranging from mild to serious lifethreatening conditions 36,41,43,44 and hospital admission rates ranging between 16.5% and 36%. 36,38,44 Similarly, chest pain is frequently cited as one of the top 5 reasons for patients' presentation to the ED, 30,33,40,45 with studies between 2014 and 2019 reporting chest pain in ED cohorts representing between 1.5% and 1.82% in sub-Saharan Africa, 46,47 4.11% and 4.7% in the United States, 30,33,48 and 11% and 13% in Norway 40,45 (where EDs require general practitioner referral 45 ).…”

“…[38][39][40] As a presenting complaint, abdominal pain has been described as a diagnostic challenge 34,41,42 for ED clinicians, with an array of potential causes ranging from mild to serious lifethreatening conditions 36,41,43,44 and hospital admission rates ranging between 16.5% and 36%. 36,38,44 Similarly, chest pain is frequently cited as one of the top 5 reasons for patients' presentation to the ED, 30,33,40,45 with studies between 2014 and 2019 reporting chest pain in ED cohorts representing between 1.5% and 1.82% in sub-Saharan Africa, 46,47 4.11% and 4.7% in the United States, 30,33,48 and 11% and 13% in Norway 40,45 (where EDs require general practitioner referral 45 ). Commensurate with abdominal pain, the cause of chest pain is diverse, [47][48][49] ranging from nonspecific to life-threatening conditions, with reported admission rates varying between 30.6% 48 and 89%.…”