Evaluation of Elderly Patients with Abdominal Pain in an Emergency Department: Factors Associated with Emergency Surgery

Abstract

Objective: To evaluate whether proper diagnoses were made at an emergency department to elderly patients who presented with abdominal pain, and to identify factors associated with acute surgical condition. Methods: A two-year retrospective review of patients aged 65 years and older complaining of abdominal pain who presented to the emergency department. Results: 189 patients were enrolled. The over all accuracy rate for emergency department diagnoses was 79%. Of the 13 (7.1%) patients with a very different diagnosis from the first diagnosis after admission, six cases were not initially recognized as an acute surgical condition, and surgery was delayed. Factors associated with acute surgical condition by univariate analyses included tachypnea, hypothermia, persistent pain, perspiration, hyperglycemia, hypoalbuminemia, hypocalcemia, and the presence of systemic inflammatory response syndrome. A multivariate, logistic regression analysis indicates that persistent pain is a possible predictive factor indicating an acute surgical condition. In all six cases where such a condition initially went unrecognized, the abdominal CT was a key resource in revealing an acute surgical condition. Conclusions: In the emergency department, diagnosis of abdominal pain in the elderly with less specific symptoms is difficult and less accurate. Persistent pain is a possible predictive factor indicating an acute surgical condition and patients with persistent pain should be evaluated by abdominal CT scan early in the evaluative process.

An 82-Year-Old Woman on Long-Term Hemodialysis with Ascites, Pneumatosis Coli, and 3 Episodes of Portal Venous Gas Associated with Intestinal Necrosis

“…Predictors of intestinal necrosis include hypotension, abdominal pain, peritoneal signs, ascites, and elevated levels of serum aminotransferase, lactate dehydrogenase (LDH), creatinine (Cr), C-reactive protein (CRP), arterial lactate, pH, and I-FABP [ 3 ]. Although bowel distension, pneumatosis intestinalis, poor bowel wall enhancement, porto-mesenteric venous gas, and arterial occlusion have been previously documented as radiological predictors [ 3 , 7 , 8 , 11 – 13 ], sample sizes of the studies were limited or various mesenteric ischemia were included. Herein, we report the case of an older woman on hemodialysis who had 3 consecutive episodes of PVG.…”