Long-term follow-up of patients diagnosed with nonspecific abdominal pain (NSAP): identification of pathology as a possible cause for NSAP

Abstract

Background Nonspecific abdominal pain (NSAP) accounts for 40 % of all general surgical admissions. Data suggest that conditions such as irritable bowel syndrome and gynaecological pathologies can be misdiagnosed as NSAP. Delayed diagnosis and management can cause increased morbidity. Our aim was to follow-up a cohort of patients with an initial diagnosis of NSAP to determine their eventual diagnosis.Method Hospital episode statistic (HES) data were reviewed to identify 100 acute surgical admissions coded as NSAP at discharge between January and December 2008. Medical records were systematically reviewed over a 3-year follow-up period to identify further investigations, operations and any eventual diagnoses in patients who fulfilled NSAP criteria. General practitioners were contacted to evaluate any further GP surgery visits and hospital referrals for this cohort of patients.Results A total of 59 were incorrectly coded as NSAP; only 41 fulfilled the criteria of NSAP at discharge from the initial acute admission. The majority of patients correctly diagnosed as NSAP were female (71 %) individuals. Median age across both genders was 25.7 years (interquartile range 19.4-37.7 years). At three yearly followup, 54 % of patients appropriately labelled as NSAP were diagnosed with a specific pathology.Conclusion This study highlights that around half of patients correctly labelled with NSAP were subsequently diagnosed with a specific pathology. Our results suggest that patients diagnosed with NSAP should be followed up to avoid additional morbidity from misdiagnosis. Furthermore, the current coding system for NSAP needs to be modified.

Características Clínicas De Pacientes Com Tomografia Computadorizada Abdominal Inespecífica Para Dor Abdominal Aguda

“…Destes, 03 casos foram por sepse e um por complicações de abdome obstrutivo por bridas. EISENBERG et al, 2017;FAGERSTRÖM et al, 2017;WATSON et al, 2015) e o acompanhamento a longo prazo de pacientes com DAI no PA tem mostrado que a probabilidade de um diagnóstico específico é semelhante entre os sexos (WATSON et al, 2015). Uma possível explicação para a maior frequência de TCAI entre as mulheres pode estar nas causas ginecológicas de DAA, para as quais a TC pode levar a diagnósticos inespecíficos ou ter interpretação equivocava (IRAHA et al, 2017).…”

“…A quantidade de de leucócitos dentro dos valores de referência costuma indicar condições não urgentes ATEMA; e foi mais comum entre pacientes com TCAI, o que pode ser de grande valor para a decisão de indicação de TC na urgência. De fato, o papel de exames laboratoriais, em especial leucograma e PCR sérico tem sido descrito como preditores para situações não urgentes no PA, quando combinados a história clínica e exame físico ATEMA;WATSON et al, 2015). No local da pesquisa, os níveis séricos normais de sódio e ureia foram solicitados em menos de 80% e o PCR, por não fazer parte do protocolo de atendimento emergencial de DAA, foi realizado em menos de 50% dos pacientes.…”

Surgery with qualities or: “how to foster yourself”

“…The authors of the present issue of European Surgery compose an harmonic symphony of themes and directories reflecting different approaches to the world of surgery and basic science [5][6][7][8][9][10]. In addition, the articles sense the highly positive notion, that there can be short lights of true awareness, off the power-tuned path of the despotism-driven "normal" life within the academy.…”

“…In addition, the articles sense the highly positive notion, that there can be short lights of true awareness, off the power-tuned path of the despotism-driven "normal" life within the academy. The colorful spectrum of papers ranges from molecular to clinical science, from open to laparoscopic and minimally invasive surgery [5][6][7][8][9][10]. The globe of variations indicates that there exist amigos out there in the surgical community who have NOT given up to raise questions, who have NOT given up their wish to discover and to understand and tune themselves with the golden shine (Fig.…”

<p>Abdominal Epilepsy, a Rare Cause of Abdominal Pain: The Need to Investigate Thoroughly as Opposed to Making Rapid Attributions of Psychogenic Causality</p>

“…Abdominal pain is a nonspecific symptom which can be caused by myriad pathologies, resulting in frequent misdiagnosis. 1 Some pathological conditions can cause paroxysmal gastrointestinal symptoms, such as porphyria, cyclical vomiting, intestinal malrotation, peritoneal bands, and abdominal migraine. 2 Furthermore, emotional and psychological factors may also play an important role in the presentation of certain patients with gastrointestinal disorders, and accurate diagnosis can be confounded by these.…”