Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Abstract

Objective: to determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain.Methods: a retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Altiplano Health Area (Murcia) was performed. In our study we considered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed diagnoses, which were retrospectively assessed by an external radiologist who was unaware of the patient's final diagnosis.Results: our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appendicitis was the main cause (approx. 25%), followed by cholecystitis (10%). We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC) and a diagnosis with cholecystitis. This location was also significant for acute appendicitis (up to 74%). Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphy's sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively.Conclusions: a) anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b) ultrasound scans offer a low diagnostic agreement index for appendicitis; and c) laparoscopy may prove useful for diagnosis, and is also a possible treatment for acute abdominal pain despite its low diagnostic efficiency.

History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis

“…We decided to remove all the retrospective studies from our review. Although, the work by Lijmer et al .…”

“…has shown that retrospective compared to prospective diagnostic studies, when corrected for methodologic flaws, do not produce different results, our retrospective studies all had significant flaws. All of our retrospective studies had issues related to reliability of their retrospectively abstracted data. Gilbert et al .…”

“…However, the possibility of acute cholecystitis (AC), which accounts for 3%–11% of hospital admissions with a mortality rate of 0.8%, usually requires a comprehensive diagnostic evaluation using the modalities of history and physical examination (H&P), laboratory results, and imaging studies. Many studies have previously described individually the H&P, laboratory, and imaging consistent with AC. The Tokyo AC guidelines by Hirota et al .…”

The role of emergency ultrasound in the diagnosis of acute non-traumatic epigastric pain

“…In their natural evolution, each disease can successively involve superficial structures, thus determining somatic well localized pain, reaching a significant correlation between pain location and definite diagnosis [15].…”

Plain abdominal radiography in acute abdominal pain; past, present, and future

“…Several studies have demonstrated that a diagnosis based solely on a patient’s medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain 2,8. Further diagnostic workup such as imaging is therefore mandatory in patients suspected of an urgent medical condition.…”