Utility of Fever and Leukocytosis in Acute Surgical Abdomens in Octogenarians and Beyond

Abstract

Acute surgical abdomen in patients 80 years or older has a unique distribution of diagnoses. Although an increase in temperature and marked leukocytosis are not diagnostic of any particular illness, their presence should suggest certain specific surgical illnesses to the practicing clinician. Frequently, elderly patients with acute surgical abdomens present with a normal temperature and leukocyte count.

Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management

“…Moreover, even in case of accurate pre-CT diagnosis, systematic unenhanced CT increased the diagnostic confidence level, as shown on the radar chart, with data points converging towards a single and accurate diagnosis with 100 % confidence. Secondly, as older patients with abdominal pain have a twofold higher surgery rate [1,4] and sixfold to eightfold higher mortality rates compared with younger adults [6,35,36], there is a tendency to more readily hospitalize older patients, irrespective of the clinical suspicion. Indeed, in patients for whom CT was not requested, unenhanced CT led to valid discharge in 15.7 % of patients for whom hospitalization would otherwise have been recommended.…”

Fever in the Elderly

“…In the old, bacteremia [16,17], endocarditis [18,19], pneumonia [20,21], and meningitis [22] may present with lower fever than in the young. In a recent study of acute surgical abdomens in octogenarians, a substantial percentage of patients with acute cholecystitis, perforation, and appendicitis presented with temperatures !37.5ЊC [23]. Finally, a current study of the occurrence of nosocomial febrile illness in patients residing in an acute geriatric-medicine unit found that the mean "febrile" rectal temperature was only 38.1ЊC.…”

JOURNAL CLUB: Acute Abdominal Pain in Elderly Patients: Effect of Radiologist Awareness of Clinicobiologic Information on CT Accuracy

“…This approach is especially interesting with respect to older populations, for which clinical diagnosis is a challenge because physical examination findings are not reliable predictors of or excluding factors for serious disease [8]. Moreover, surgical diseases are more frequent in elderly than in younger population and have a specific distribution [18]. Surgical delay has also been pointed out as being a crucial morbidity and mortality factor in older age groups [19].…”