Non-traumatic Acute Abdominal Pain Research Articles

Application of three-step communication method based on SBAR standard model in emergency patients with non-traumatic abdominal pain

Objective To observe the effect of three-step communication based on SBAR standard model in emergency patients with non-traumatic abdominal pain. Methods Patients with acute non-traumatic abdominal pain admitted to the hospital before (January to May, 2017) and after (June to October, 2017) the three-step communication method based on the SBAR standard model were selected, with 49 cases in each group as research objects.Patients were divided into control group and experimental group before and after the implementation.The observation indexes of the two groups were compared before and after the implementation. Results After intervention, the incidence of communication-related safety events in the experimental group was significantly lower than that in the control group, and the clinical communication ability score and communication experience score of emergency nursing staff were significantly higher than those before implementation, and the differences were statistically significant(P<0.05). Conclusion The application of three-step communication method based on SBAR standard model in emergency patients with non-traumatic abdominal pain can significantly promote the communication ability of emergency nurses, improve their communication experience, and reduce the incidence of communication-related safety incidents. Key words: SBAR; Communication; Non-traumatic abdominal pain; Emergency

Acute non-traumatic abdominal pain by quadrant: relative yield of CT and clinical evaluation for diagnosis in 1000 patients.

To determine the relative diagnostic yield of contrast-enhanced CT in adults presenting with symptoms referable to a specific abdominal quadrant. Electronic health records review systematically identified patients meeting the following inclusion criteria: adults (≥ 18years) undergoing IV contrast-enhanced abdominopelvic CT for acute non-traumatic symptoms referable to a specific abdominal quadrant (RLQ/LLQ/LUQ/RUQ). The CT-based diagnosis and any clinical diagnosis in the absence of CT diagnosis were recorded. The final cohort of 1000 subjects (mean age, 48.1years; 647F/353M) consisted of consecutive sub-cohorts of 250 patients for each abdominal quadrant. Positive oral contrast was utilized in 91.6% (916/1000) of cases. A positive CT diagnosis was provided in 47.3% (473/1000) of all patients, and was highest for LLQ (58.8%) and RLQ (58.0%) symptoms, including diverticulitis and appendicitis in 23.6% and 24.8% cases, respectively. CT positivity was lower for the LUQ (34.4%) and RUQ (38.0%) (p < 0.0001), with no single diagnosis representing > 5% of cases. However, all quadrants provided valuable triage of 218 hospital admissions (21.8%), 83.0% were CT positive, whereas 62.7% of 782 discharged patients were CT negative. Only 7.0% of CT-negative patients were admitted. A clinical-only diagnosis was provided in 9.3% of the total cohort (93/1000), representing 17.6% of the CT-negative cohort (93/527). The rate of positive CT diagnosis is considerably higher for the lower abdominal quadrants, predominately due to appendicitis and diverticulitis. However, CT results (positive vs. negative) for all four quadrants strongly correlated with hospital admission versus discharge. Clinical-only diagnosis represented < 10% of all cases.

Non Traumatic Acute Abdominal pain (100 days study in Emergency Department)

Background: Abdominal symptoms are possibly the most frequent of all symptoms encountered in surgical practice. Pain is the most common of all abdominal symptoms. Causes of acute abdominal pain include both medical and surgical. Most symptoms arise from intra-abdominal organs or systems while some may originate extra abdominally and are then referred to the abdomen. Medical causes of abdominal pain are encountered more frequently.&#x0D; Objective: To study the causes of acute abdominal pain in patients attending emergency department in Al- Imamain Al- Kadhimain Medical City.&#x0D; Type of the study: A prospective cross sectional study&#x0D; Methods: The patients attending Emergency Department in Al- Imamain Al- Kadhimain Medical City over the period from April-2014 to April 2016. There was a one day call duty per week managed by the same surgical team (total one hundred days study). Onlypatients above 12 years old with acute non-traumatic abdominal pain were included in this study.&#x0D; Results: The total number was 1217 patients over hundred days study. Their age ranges from 12-83 years; average age was 36.18 ±17 year. There was slight female predominance, 638 (52.42%) female patients and 579 (47.58%) male patients. The most common cause of abdominal pain was acute appendicitis 252 (20.70%), followed by ureteric colic 251 (20.62%), and acute cholecystitis249 (20.46%). Conservative management was done for 836 (68.69%) patients, while operative management done for 379 (31.14%) patients. Postoperative mortality was 8 (2.11%) patients.Medical causes of acute abdominal pain were found in 48 (5.74%) patients.&#x0D; Conclusion: Not all the patients attending surgical emergency department needs operations. Causes of acute abdominal pain include both medical and surgical diseases, some of the medical diseases are very serious like acute viral hepatitis, myocardial infarction , and diabetic ketoacidosis; and should not submit those patients to unnecessary operations with serious and may be fatal postoperative complications. General urine examination is a must in all patients with acute abdominal pain. Electrocardiography (ECG) may be needed in old patients.

Clinical spectrum of acute abdomen in children admitted to pediatric emergency department: A prospective study

IntroductionAcute abdominal pain accounts for about 8% of all children attending the emergency department (ED) (Balachandran et al., 2013). In spite of being a common symptom seen in children, it is not uncommon for it to be a manifestation of a serious surgical emergency. There are inadequate published data from India regarding the spectrum of acute abdominal pain in children. ObjectiveThe objective of this study was to assess the clinical profile of children with nontraumatic acute abdominal pain admitted in the pediatric ED. MethodologyThis prospective observational study was conducted between June 2016 and July 2017. All the records of children aged between 2 and 18 years presenting with complaints of abdominal pain were collected in a predesigned proforma at the time of admission in the pediatric ED. Children who had undergone previous abdominal surgery and those with a history of trauma were excluded. ResultsA total of 720 children attending ED with complaints of abdominal pain were seen by the surgical team. According to their final diagnosis, they were divided into two groups: group I, 58 (8%; surgical); group II, 662 (92%; nonsurgical). Mean age of presentation was 7.5 ± 5.7 years; male-to-female ratio was 1.6:1. Detailed history and pain characteristics help in establishing the cause of pain. ConclusionThe cause of pain in more than 90% of children presenting in the pediatric ED with complaints of abdominal pain is nonsurgical. Constipation was the most common diagnosis in these children, followed by acute gastroenteritis. Only in 8% children, the cause of pain is surgical, and acute appendicitis is the most common surgical cause.

The Acute Abdomen Decision Making course for the initial management of non traumatic acute abdomen: A proposition of the World Society of Emergency Surgeons

The Acute Abdomen Decision Making course® (AADM®) was developed by the World Society of Emergency Surgeons (WSES) members with the purpose to teach a systematic and concise method for approaching acute abdomen patient. It was first introduced in 2016. The course explains step by step the clinical reasoning to follow for immediate managing of the acute abdomen in emergency department with a safe and reliable method. We developed this original decision making model AADM following the Advanced Trauma Life Support (ATLS) philosophy in evaluating non-traumatic abdominal pain patient. The A-B-C-D-E-F management of non-traumatic acute abdominal pain is conceived by WSES to make easy and systematic the evaluation of patients in Emergency Department. AADM course teaches how to assess an acute abdomen patient’s diagnosis and determine the therapeutic approach to reduce unnecessary exams and hospitalizations.

Concomitant leukocytosis and lymphopenia predict significant pathology at CT of acute abdomen: a case-control study

BackgroundAcute abdominal pain accounts for about 10% of emergency department visits and has progressively become the primary indication for CT scanning in most centers. The goal of our study is to identify biological or clinical variables able to predict or rule out significant pathology (conditions requiring urgent medical or surgical treatment) on abdominal CT in patients presenting to an emergency department with acute abdominal pain.MethodsThis was a retrospective cohort study performed in the emergency department of an academic center with an annual census of 60′000 patients. One hundred and-nine consecutive patients presenting with an acute non-traumatic abdominal pain, not suspected of appendicitis or renal colic, during the first semester of 2013, who underwent an abdominal CT were included.Two medical students, completing their last year of medical school, extracted the data from patients’ electronic health record. Ambiguities in the formulations of clinical symptoms and signs in the patients’ records were solved by consulting a board certified emergency physician. Nine clinical and biological variables were extracted: shock index, peritonism, abnormal bowel sounds, fever (> 38 °C), intensity and duration of the pain, leukocytosis (white blood cell count >11G/L), relative lymphopenia (< 15% of total leukocytes), and C-reactive Protein (CRP). These variables were compared to the CT results (reference standard) to determine their ability to predict a significant pathology.ResultsSignificant pathology was detected on CT in 71 (65%) patients. Only leukocytosis (odds ratio 3.3, p = 0.008) and relative lymphopenia (odds ratio 3.8, p = 0.002) were associated with significant pathology on CT. The joint presence of these two anomalies was strongly associated with significant pathology on CT (odds ratio 8.2, p = 0.033). Leukocytosis with relative lymphopenia had a specificity of 89% (33/37) and sensitivity of 48% (33/69) for the detection of significant pathology on CT.ConclusionThe high specificity of the association between leukocytosis and relative lymphopenia amongst the study population suggests that these parameters would be sufficient to justify an emergency CT. However, none of the parameters could be used to rule out a significant pathology.

Serum cortisol level as a useful predictor of surgical disease in patients with acute abdominal pain

Introduction. The immediate aim should be to identify potentially resuscitative acute abdominal pain that requires prompt investigation or early surgical interven-tion. We aimed to evaluate whether serum cortisol levels differentiate surgical and non-surgical disease in patients with acute abdominal pain.&nbsp;Materials and methods. In this prospec-tive cross-sectional study, the primary end-point was defined as differences in serum cortisol levels between surgically and non-surgically treated patients with non-traumatic acute abdominal pain. The secondary end-point was to compare the cortisol levels with defined complete blood count (CBC) parameters in those groups. Results. One hundred eleven patients with acute abdominal pain were included in the study. Three most frequent diagnoses were nonspecific abdominal pain, acute appendicitis and dyspeptic complaints. Thirty patients were hospitalized and 22 of them were operated. The median cortisol level was 23.13 µg/dl in surgically treated patients and 13.94 µg/dl in non-surgically treated patients (p&lt;0.001). The area under the ROC curve using cortisol to detect surgical disease was 0.750 (95% CI, 0.659-0.827) and the accuracy of cortisol to de-tect surgical disease was not inferior to de-fined CBC parameters. A cortisol value of 17.98 µg/dl had a sensitivity of 67.4% and a specificity of 77.3% for surgical disease. Conclusion. Operated patients had higher serum cortisol levels. High serum cortisol levels may indicate surgical disease at the early stage on admission in ED patients with acute abdominal pain and may be used as a marker in the prediction of acute surgical abdomen.

Imaging strategies for evaluating non-traumatic acute abdominal pain

Imaging strategies for evaluating non-traumatic acute abdominal pain

A study on the identification and management of non-traumatic acute abdominal pain

A study on the identification and management of non-traumatic acute abdominal pain

Implications of Ultrasonography in the Diagnosis and Management of Patients Presenting with Non-Traumatic Acute Abdominal Pain in a Tertiary Hospital of Mid-Western Region of Nepal

Introduction: Acute abdomen is the most common condition for patients presenting in the emergency. Ultrasound among other imaging modalities is the most common diagnostic tool employed in the diagnosis of such cases.Methods: A prospective study of consecutive patients presenting with acute abdomen fulfilling the inclusion and exclusion criteria were included in the study. Ultrasound was performed by single radiologist and findings were correlated to the clinical, pathological and surgical findings.Results: A total of 248 patients fulfilled all criteria and were included in the study. The age of patients ranged from 15-62 years with mean age of 41.3 years. There was female predominance with a male to female ratio of 1:1.8. Ultrasound accurately diagnosed 233 cases (93.9 %). Urolithiasis was the most common finding (45.16%) followed by acute appendicitis (19.35%).Conclusion: Ultrasound has pivotal role in the diagnosis and overall management of patient presenting with acute abdomen. Urolithiasis is the most common etiology for non- traumatic acute abdomen.

The Comparison of Appropriateness of Abdominal Computed Tomography (CT) and Abdominal Radiography Imaging Modality for Patients with Acute Nontraumatic Abdominal Pain

The Comparison of Appropriateness of Abdominal Computed Tomography (CT) and Abdominal Radiography Imaging Modality for Patients with Acute Nontraumatic Abdominal Pain

Appropriateness of CT scans for patients with non-traumatic acute abdominal pain.

Acute abdominal pain is the most common reason for surgical admission. CT scans are increasingly used to aid early diagnosis. Excessive use of CT scans is associated with increased length of stay, healthcare costs and radiation. The aim of this study was to evaluate the appropriateness of CT scans for patients presenting with acute abdominal pain. We examined 100 consecutive patients presenting with new acute abdominal pain who underwent a CT scan. Clinical information available at the time the scan was ordered, was summarised and reviewed independently by five consultant general surgeons and five consultant radiologists. A CT scan was judged to be not indicated in a median of 21% of cases (range 12-53%), more information was required in a median of 16% (0-41%) and in a median of 58% (37-88%) the CT scan was considered indicated. There was a good level of agreement (Cronbach's α 0.704) across the 10 experts. These data suggest that a large proportion of CT scans for patients with acute abdominal pain are not clinically indicated or are being performed prior to adequate clinical work-up. Optimising CT scan requests for this patient group will improve use of healthcare resources. Advances in knowledge: Both radiologists and general surgeons agree that there is no indication for an abdominal CT scan for a patient presenting with acute abdominal pain in a median of 21% of the cases.

Efficacy of scheduled return visits for emergency department patients with non-specific abdominal pain

IntroductionMany patients presenting with abdominal pain to emergency departments (EDs) are discharged without a definitive diagnosis. For these patients, often designated as having non-specific abdominal pain, re-evaluation is often advocated....

Focused Abdominal Computed Tomography in Clinically Suspected Adolescent Acute Appendicitis

Background: Acute appendicitis (AA) is one of the most common causes of acute non-traumatic abdominal pain. The use of computed tomography (CT) in facilitating the diagnosis of AA in patients above the age of 50 where right iliac fossa (RIF) pain may represent a wide spectrum of differentials is well established. However, few studies have explored the value of low radiation, unenhanced focused abdominal computed tomography (FACT) in adolescent patients where AA represents the main differential for RIF pain. In this study, we aimed to examine the diagnostic accuracy of FACT scan in diagnosing AA in adolescent patients at a tertiary teaching children’s hospital. Methods: The study was based on cross-sectional design and occurred over a 6-month period between November 2008 and May 2009. A prospective cohort of 95 patients between the ages of 10 - 21 years with clinically suspected AA satisfied the inclusion criteria. Patients with recent abdominal surgery or those who were pregnant were excluded from the study. The necessary institutional ethical approval was granted prior to study commencement. Results: There was slight male preponderance of 51 patients (54%) and 44 females (46%). The mean age of AA was 12.75 ± 2.7 years (range 10 - 21). Statistical analysis showed FACT scan was 97.32% sensitive, 88.42% specific, with a positive predictive value of 98.8% and a negative predictive value of 80.0% in diagnosis of AA. The overall diagnostic accuracy of FACT scan in our study was 96.8%. Conclusions: Unenhanced FACT scan is rapid, cost-effective and safe in diagnosis of adolescent AA. J Curr Surg. 2018;8(1-2):7-12 doi: https://doi.org/10.14740/jcs339w

Should plain radiographs persist or be replaced by alternative scans for imaging of acute painful non-traumatic abdominal pain?

Purpose: Acute non-traumatic abdominal pain (ANTAP) is a frequent presentation at the emergency department (ED). Plain abdominal radiographs (PAR's) were historically the principal imaging tool. The objective of this study was to determine whether PAR's are still in use for ANTAP diagnosis. The other objective was to determine whether PAR’s stood-alone or were they a redundant step delaying the definitive imaging test. When CT scans were added to PAR's, the sensitivity and specificity of the two modalities were compared. Methods: A report of a retrospective study conducted at an 800-bed hospital ED between 01.06.2014 and 30.06.2014. All patients aged 15 and above who presented with ANTAP and referred first for PAR’s were included. Traumatic, obstetric, gynaecologic cases were excluded. The discharge diagnosis was considered the gold standard. Main findings: The study included 756 patients. 375 (49.6%) were males, 381 (50.4%) were females. The age range was 15 to 92 yrs. Mean age was 46 yrs. The most common presentation was an unclassified abdominal pain in 516 (68%). PAR's were requested alone for 594 (78.5%) and in combination with Conventional CT in 103 (13.6%). Low dose CT was added for 33 (4.3%). The sensitivity of PAR's and CT for urinary stones was 32.8% and 91.3% respectively. The sensitivity of PAR's and CT for intestinal obstruction was 50% and 83.3% respectively. Conclusion: PAR's are still in use as a one-stop shop for imaging the majority of patients presenting with ANTAP. In patients who had both CT and PAR's, there was a low PAR's sensitivity leading to poor congruence in diagnosing abnormal cases. However, CT delivered a higher radiation dose. There is a need to replace the conventional CT and PAR's for ANTAP imaging.

CT for Acute Nontraumatic Abdominal Pain—Is Oral Contrast Really Required?

This study aims to compare the diagnostic performance of abdominal computed tomography (CT) performed with and without oral contrast in patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain. Between December 2013 and December 2014, 348 adult patients presenting to the ED of a large tertiary medical center with nontraumatic abdominal pain were evaluated. Exclusion criteria for the study were history of inflammatory bowel disease, recent abdominal operation and suspected renal colic, abdominal aortic aneurysm rupture, or intestinal obstruction. All patients underwent intravenous contrast-enhanced abdominal CT on a Philips Brilliance 64-slice scanner using a routine abdomen protocol. The study group included 174 patients who underwent abdominal CT scanning without oral contrast, recruited using convenience sampling. A control group of 174 patients was matched to the cohort groups' gender and age and underwent abdominal CT with oral contrast material during the same time period. The patients' medical records were reviewed for various clinical findings and for the final clinical diagnosis. The CT exams were initially reviewed by a senior attending radiologist to determine the exams' technical adequacy and to decide whether an additional scan with oral contrast was required. Two senior radiologists, blinded to the clinical diagnosis, later performed consensus reading to determine the contribution of oral contrast administration to the radiologists' diagnostic confidence and its influence on diagnosing various radiological findings. Each group consisted of 82 men and 92 women. The average age of the two groups was 48 years. The main clinical diagnoses of the pathological examinations were appendicitis (17.5%), diverticulitis (10.9%), and colitis (5.2%). A normal CT examination was found in 34.8% of the patients. There was no significant difference between the groups regarding most of the clinical parameters that were examined. None of the examinations of all of the 174 study group patients was found to be technically inadequate, and therefore no patient had to undergo additional scanning to establish a diagnosis. The consensus reading of the senior radiologists determined that the lack of oral contrast was insignificant in 96.6% of the cases and that contrast material might have been useful in only 6 of 174 study group patients (3.4%). The radiologists found oral contrast to be helpful only in 8 of 174 control group patients (4.6%). There was no significant difference between the clinical and radiological diagnoses in both groups (study group, P = 0.261; control group, P = 0.075). Our study shows that oral contrast is noncontributory to radiological diagnosis in most patients presenting to the ED with acute nontraumatic abdominal pain. These patients can therefore undergo abdominal CT scanning without oral contrast, with no effect on radiological diagnostic performance.

Clinical Outcome of Nontraumatic Acute Abdominal Pain in Paediatric Patients Admitted in General Surgery Department

Clinical Outcome of Nontraumatic Acute Abdominal Pain in Paediatric Patients Admitted in General Surgery Department

PLACE DE L’IMAGERIE DANS LE DIAGNOSTIC DES DOULEURS ABDOMINALES AIGUËS DE L’ADULTE AUX URGENCES CHIRURGICALES DE L’HOPITAL ARISTIDE LE DANTEC

Aim : To report the imaging strategies in the diagnosis of acute non-traumatic acute abdominal pain in adult patient. Patients and methods: We performed aforward-looking study over a period of 12 months including 153 patients. The inclusion criteria were the presence of abdominal pain evolving for less than 7 days without abdominal trauma and an age of 16 year and over. The imaging exams, the modalities of their association, their indications as well as their results were reported. Results: One hundred and thirty-one patients (85,6%) had imaging exams. Ninety seven patients (61%) had an ultrasound done, 47 patients (29,6%) had a plain abdominal radiography, whereas computed tomography was done in 15 patients (9,4%).Ultrasound was performed alone in 73 patients (45,9%), plain abdominal radiography as well in 27 patients (17%) and computed tomography in 4 patients (2,5%). Plain abdominal radiography was associated to ultrasound in 16 patients (20,2%), and to computed tomography in 3 patients (3,8%). Ultrasound and computed tomography were associated in 7patients (8,8%) whereas the 3exams were associated in 1 patient (1,4%).The affections for which plain abdominal radiography was performed were: bowel obstruction (n=23), peritonitis(n=17), appendicitis (n=3), non-specific abdominal pain (n=3) and cholecystolithiasis(n=1). Ultrasound was realized for appendicitis (n=50), peritonitis (n=15), gynecological peritonitis, urinary lithiasis and liver steatosis (n=1) in each case. Computed tomography was performed for bowel obstruction (n=10), peritonitis, strangulated eventration, appendicitis, necrobiotic fibroma of the uterus and non-specific abdominal pain (n=1) in each case. Plain abdominal radiography found abnormal results in 38 patients (80.8%); while ultrasound and CT suggested a correct diagnosis in 72.4% and 80% of cases respectively. Conclusion: Imaging is an important diagnostic tool for acute abdominal pains. Ultrasound and plain abdominal radiography are the commonest exams. Key-words: acute abdominal pain, imaging, ultrasound, computed tomography, plain abdominal radiography.

Acute abdominal pain in children: usefulness of three-view abdominal radiographs in the emergency department.

Diagnostic imaging is often an integral component in the workup of a pediatric patient with acute abdominal pain. The purpose of this study was to compare the diagnostic value of a three-view acute abdominal series (AAS) with that of a single supine view (SSV) in children with acute abdominal pain. All subjects aged ≤18years that underwent an emergency three-view AAS examination for acute abdominal pain at a single urban hospital system were included. Retrospective evaluation of radiological diagnosis, number of radiological images, further imaging, management, and clinical outcomes was performed. "Positive" AAS studies were compared with corresponding SSV images for direct comparison of diagnostic value. Standard nonparametric statistical evaluation was performed. Five hundred forty-one AAS studies were included in the study. Greater than three radiographs were acquired in 29% (153/541) of the subjects. Two hundred ninety-nine out of 541 AAS studies included a technically adequate SSV of the abdomen and pelvis. Most AAS examinations were categorized as negative (n=485; 90%). Of the 56 examinations initially classified as positive, there was no significant statistical difference between diagnostic accuracy between the AAS and SSV on retrospective evaluation. For pediatric subjects with nontraumatic acute abdominal pain, the yield of conventional radiographic study is exceedingly low. If required, a technically adequate single supine anteroposterior (AP) view of the abdomen and pelvis is sufficient for initial radiographic evaluation while reducing unnecessary radiation exposure to the patient.

Oral contrast for CT in patients with acute non-traumatic abdominal and pelvic pain: what should be its current role?

Positive oral contrast agents, including barium suspensions and water-soluble iodinated solutions, have traditionally been used in conjunction with the CT evaluation of patients with abdominal and pelvic pain. Due to continued advancements in CT technology, and due to increasing obesity and correspondingly a general increase in the intra-abdominal and intra-pelvic fat separating bowel loops in North American patients and in patients in other parts of the world over the past few decades, the ability of radiologists to accurately evaluate the cause of acute symptoms has substantially improved. Recent research and evolving imaging society guidelines/systematic reviews increasingly support performing CT scans of the abdomen and pelvis without the need for positive oral contrast in these types of adult patient populations, in most clinical situations. Increased patient throughput, patient preference, patient safety, and most importantly, retention of high diagnostic accuracy, are reasons for this recent change in practice to routinely omit the use of enteric contrast agents for the majority of patients presenting with acute abdominal and pelvic pain whom are undergoing emergency CT.