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

Abstract

Background Patients who call for emergency medical services (EMS) due to abdominal pain suffer from a broad spectrum of diseases, some of which are time sensitive. As a result of the introduction of the concept of ‘optimal level of care‘, some patients with abdominal pain are triaged to other levels of care than in an emergency department (ED). We hypothesised that it could be challenging in a patient safety perspective. Aim This study aims to describe consecutive patients who call for EMS due to abdominal pain and are triaged to self-care by EMS clinicians. Methods This was an observational study performed in an EMS organisation in Western Sweden during 2020. The triage tool Rapid Emergency Triage and Treatment System (RETTS), which included Emergency Signs and Symptom (ESS) codes, was used to find medical records where patients with abdominal pain have been triaged to self-care and 194 patients was included in the study. Results Of total 48,311 ambulance missions, A total of 1747 patients were labelled with ESS code six (abdominal pain), including 223 (12.8%) who were given the code for self-care and 194 who were further assessed by the research group. Of these patients, 32 (16.3%) had a return visit within 96 hours due to the same symptoms and 11 (5.6%) were hospitalised. In six of these patients, the EMS triage was evaluated retrospectively and assessed as inappropriate. These patients had a final diagnosis of ruptured abdominal aneurysm (n = 1), acute appendicitis with peritonitis (n = 2) and acute pancreatitis (n = 3). All these patients required extensive evaluation and different treatments, including acute surgery, antibiotics and fluid therapy. Conclusion Amongst the 1747 patients assessed by EMS due to abdominal pain, 223 (12.8%) were triaged to self-care. Of the 194 patients who were further assessed, 16.3% required a return visit to the ED within 96 hours and 5.6% were hospitalised. Six patients had obvious time-sensitive conditions. Our study highlights the difficulties in the early assessment of abdominal pain and the requirement for an accurate decision support tool.

Increasing emergency number utilisation is not driven by low-acuity calls: an observational study of 1.5 million emergency calls (2018–2021) from Berlin

“…The EMS Berlin has recently expanded its code list for transfer to the OCMS [ 49 ], including many Alpha codes which are frequent in our analysis. For example, abdominal pain requires ED treatment only in a minority of cases, although these are not always trivial to identify [ 50 ]. The considerable number of upcodings (B00/C00) in the dataset indicates that the transferral is not always possible, at least partly due to OCMS capacity.…”

Initial approach to the patient with abdominal pain

“…Worldwide, an increase in the demand for emergency medical services has been observed [1]. Among the reasons suggested for this phenomenon are ageing of the population, the increase in health awareness and socio-demographic factors [2,3].…”

“…In the United States, in 2006, of the 119 million presentations in emergency departments, 8 million presentations (7%) were for abdominal pain [6]. In Western Sweden, for the year 2020, 48,311 ambulance missions were reported and in 1,747 cases the reason for the request was represented by abdominal pain [3]. Despite the progress made in the diagnosis management of abdominal pain, in approximately 25% of patients receiving medical care in emergency departments and in 35-41% of hospitalized patients no specific cause for abdominal pain is identified [7,8].…”