Studies of the symptom abdominal pain--a systematic review and meta-analysis

Viniol, Annika; Keunecke, Christian; Biroga, Tobias; Stadje, Rebekka; Dornieden, Katharina; Bösner, Stefan; Donner-Banzhoff, Norbert; Haasenritter, Jörg; Becker, Annette

doi:10.1093/fampra/cmu036

Cited by 105 publications

(87 citation statements)

References 17 publications

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“…Alleviating pain has historically not been deemed appropriate in the early stages of presentation with acute abdomen, as it may conceal clinical signs of peritonitis. Although several published reports condemn this regimen [6,15], the present findings show that the care practice is not always in line with research findings. Analgesics in the ED often needed to be prescribed by a physician, while a wide variety of range orders in the ambulance care and at the surgical wards were common.…”

Section: Discussioncontrasting

confidence: 87%

Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain

Athlin

Juhlin

Jangland

2016

Evaluation Clinical Practice

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Rationale, aims and objectives Evidence-informed healthcare is the fundament for practice, whereby guidelines based on the best available evidence should assist health professionals in managing patients. Patients seeking care for acute abdominal pain form a common group in acute care settings worldwide, for whom decision-making and timely treatment are of paramount importance. There is ambiguity about the existence, use and content of guidelines for patients with acute abdomen. The objective was to describe and compare guidelines and management of patients with acute abdomen in different settings across the acute care delivery chain in Sweden. Method A national cross-sectional design was used. Twenty-nine ambulance stations, 17 emergency departments and 33 surgical wards covering all six Swedish health regions were included, and 23 guidelines were quality appraised using the validated Appraisal of Guidelines for Research & Evaluation II tool. Results There is a lack of guidelines in use for the management of this large group of patients between and within different healthcare areas across the acute care delivery chain. The quality appraisal identified that several guidelines were of poor quality, especially the in-hospital ones. Further, range orders for analgesics are common in the ambulance services and the surgical wards, but are seldom present in the emergency departments. Also, education in pain management is more common in the ambulance services. These findings are noteworthy as, hypothetically, the same patient could be treated in three different ways during the same care episode. Conclusions There is an urgent need to develop high-quality evidence-based clinical guidelines for this patient group, with the entire care process in focus.

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Section: Discussioncontrasting

confidence: 87%

Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain

Athlin

Juhlin

Jangland

2016

Evaluation Clinical Practice

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“…In the community setting, a recent literature review by Viniol et al concluded that there is much need for better guidelines and decision-support tools for such patients in the primary care. 7 Moreover, during the triage sequence in the emergency department, physicians are used to applying risk-stratification calculations in order to assess, both short- and long-term prognosis, according to their working diagnosis. For example, Dipaola et al discussed the importance of risk stratification of patients presenting with syncope to the ED, 8 Kang et al present a risk stratification model for cases of acute pyelonephritis in order to indicate cases necessitating hospital admission, 9 Spinar et al, 10 and others, further improved our knowledge regarding the appropriate risk stratification process of patients with acute heart failure.…”

Section: Discussionmentioning

confidence: 99%

Vomiting and Hyponatremia Are Risk Factors for Worse Clinical Outcomes Among Patients Hospitalized Due to Nonsurgical Abdominal Pain

Goren

Israel

Neiderman³

et al. 2016

Medicine

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After initial evaluation in the Emergency Department (ED), many patients complaining of abdominal pain are classified as suffering from nonsurgical abdominal pain (NSAP). Clinical characteristics and risk factors for worse prognosis were not published elsewhere.Characterizing the clinical profile of patients hospitalized due to NSAP and identifying predictor variables for worse clinical outcomes.We made a retrospective cohort analysis of patients hospitalized due to NSAP compared to matched control patients (for age, gender, and Charlson comorbidity index) hospitalized due to other, nonsurgical reasons in a ratio of 1 to 10. We further performed in-group analysis of patients admitted due to NSAP in order to appreciate variables (clinical and laboratory parameters) potentially associated with worse clinical outcomes.Overall 23,584 patients were included, of which 2144 were admitted due to NSAP and 21,440 were matched controls. Patients admitted due to NSAP had overall better clinical outcomes: they had lower rates of in-hospital and 30-days mortality (2.8% vs 5.5% and 7.9% vs 10.4% respectively, P < 0.001 for both comparisons). They also had a significantly shorter length of hospital stay (3.9 vs 6.2 days, P < 0.001). Rates of re-hospitalization within 30-days were not significantly different between study groups. Among patients hospitalized due to NSAP, we found that vomiting or hyponatremia at presentation or during hospital stay were associated with worse clinical outcomes.Compared to patients hospitalized due to other, nonsurgical reasons, the overall prognosis of patients admitted due to NSAP is favorable. The combination of NSAP with vomiting and hyponatremia is associated with worse clinical outcomes.

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“…Abdominal pain is a common problem & constitutes about 3% of the hospital visit among adults [1]. It may be acute or chronic.…”

Section: Introductionmentioning

confidence: 99%

Role of ultrasonogram in chronic lower abdominal pain: special reference to gyenecologoical problems

Chandran

Verma

2017

Obs Gyne Reivew J Obstet Gynecol

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Studies of the symptom abdominal pain--a systematic review and meta-analysis

Cited by 105 publications

References 17 publications

Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain

Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain

Vomiting and Hyponatremia Are Risk Factors for Worse Clinical Outcomes Among Patients Hospitalized Due to Nonsurgical Abdominal Pain

Role of ultrasonogram in chronic lower abdominal pain: special reference to gyenecologoical problems

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