Standard Outpatient Re‐Evaluation for Patients Not Admitted to the Hospital After Emergency Department Evaluation for Acute Abdominal Pain

Abstract

BackgroundThe aim of the present study was to investigate the efficacy and safety of standard outpatient re-evaluation for patients who are not admitted to the hospital after emergency department surgical consultation for acute abdominal pain.MethodsAll patients seen at the emergency department between June 2005 and July 2006 for acute abdominal pain were included in a prospective study using a structured diagnosis and management flowchart. Patients not admitted to the hospital were given appointments for re-evaluation at the outpatient clinic within 24 h. All clinical parameters, radiological results, diagnostic considerations, and management proposals were scored prospectively.ResultsFive-hundred patients were included in this analysis. For 148 patients (30%), the final diagnosis was different from the diagnosis after initial evaluation. Eighty-five patients (17%) had a change in management after re-evaluation, and 20 of them (4%) were admitted to the hospital for an operation. Only 6 patients (1.2%) had a delay in diagnosis and treatment, which did not cause extra morbidity.ConclusionsStandard outpatient re-evaluation is a safe and effective means of improving diagnostic accuracy and helps to adapt management for patients that are not admitted to the hospital after surgical consultation for acute abdominal pain at the emergency department.

A report on an acute, in-hours, outpatient review clinic with ultrasonography facilities for the early evaluation of general surgical patients

“…2 However, evaluation of outpatient follow-up of emergency surgical patients presenting to the ED has not been well reported in the literature. 5 Onur et al conducted a randomised controlled trial showing that patients presenting to the ED with acute non-specific abdominal pain who were discharged home and followed up daily displayed no significant differences in either complications or morbidity compared with those admitted to hospital for observation. 6 Outpatient follow-up was deemed a safe course of management for these patients.…”

“…5 They prospectively evaluated patients presenting to the ED with acute abdominal pain who were not admitted to hospital but were asked to reattend a consultant-led outpatient clinic after 24 hours for re-evaluation. Following this re-evaluation, 46% were discharged home after only one visit to the clinic while 17% of reattending patients had their management plan changed, with 4% requiring a laparotomy (where previously only outpatient follow-up had been arranged).…”

Influence of the use of Decision Tools for Appendicitis and Diverticulitis on Diagnostic Certainty in the Emergency Department

“…Several studies though, have demonstrated that medical history and physical examination alone lead to misdiagnosis resulting in delayed or inadequate treatment [1,2,14]. Therefore most patients are referred for additional imaging [3,6,13]. However, only 50% of patients with clinical suspicion, who are referred for imaging, are ultimately diagnosed with acute appendicitis or diverticulitis [1].…”

“…Acute abdominal pain accounts for almost 10% of all emergency department visits [1][2][3]. Acute appendicitis and acute diverticulitis are frequently suspected serious causes for acute abdominal pain [1][2][3].…”

“…Acute appendicitis and acute diverticulitis are frequently suspected serious causes for acute abdominal pain [1][2][3]. Correctly identifying patients with acute appendicitis or acute diverticulitis is a diagnostic challenge [4][5][6][7][8][9][10][11].…”