Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes
Abstract
1. Introduction
2. Methods
2.1. Study Design
2.2. Selection of Participants
2.3. Data Collection
2.4. Outcomes
2.5. Statistical Analyses
3. Results
3.1. Study Enrolment
3.2. Diagnoses
3.3. Representations
3.4. Extra-Abdominal Diagnoses
3.5. Prognosis
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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All (n = 3960) | <65 Years (n = 2652) | ≥65 Years (n = 1308) | ||||
---|---|---|---|---|---|---|
Abdominal Pain | No Abdominal Pain | Abdominal Pain | No Abdominal Pain | Abdominal Pain | No Abdominal Pain | |
Presentations, n (%) | 480 (12.1) | 3480 (87.9) | 339 (12.8) | 2313 (87.2) | 141 (10.8) | 1167 (89.2) |
Age (years), median (Q1, Q3) | 47 (32, 68) | 51 (33, 72) | 39 (27, 49) | 39 (28, 51) | 77 (71, 84) | 78 (72, 85) |
Sex (female), n (%) | 253 (52.7) * | 1659 (47.7) | 184 (54.3) * | 1079 (46.6) | 69 (48.9) | 580 (49.7) |
ESI, n (%) | ** | ** | ||||
1 | 4 (0.8) | 48 (1.4) | 2 (0.6) | 17 (0.7) | 2 (1.4) | 31 (2.7) |
2 | 123 (25.7) | 705 (20.3) | 78 (23.1) | 342 (14.8) | 45 (32.1) | 363 (31.2) |
3 | 257 (53.8) | 1281 (36.9) | 177 (52.4) | 714 (30.9) | 80 (57.1) | 567 (48.7) |
4 | 88 (18.4) | 1317 (37.9) | 76 (22.5) | 1133 (49.0) | 12 (8.6) | 184 (15.8) |
5 | 6 (1.3) | 125 (3.6) | 5 (1.5) | 105 (4.5) | 1 (0.7) | 20 (1.7) |
All (n = 556) | <65 Years (n = 377) | ≥65 Years (n = 179) | |||
---|---|---|---|---|---|
Diagnosis | n (%) | Diagnosis | n (%) | Diagnosis | n (%) |
Gastroenteritis | 60 (10.8) | Gastroenteritis | 54 (15.1) | Diverticulitis | 13 (7.3) |
NSAP * | 58 (10.4) | NSAP * | 53 (14.1) | Cholelithiasis | 10 (5.6) |
Cholelithiasis | 25 (4.5) | Urolithiasis | 22 (5.8) | Urinary retention | 9 (5.0) |
Urolithiasis | 24 (4.3) | Appendicitis | 19 (5.0) | Gastroenteritis | 8 (4.5) |
Diverticulitis | 21 (3.8) | Cholelithiasis | 15 (4.0) | Small bowel obstruction | 8 (4.5) |
Appendicitis | 21 (3.8) | Urinary tract infection | 12 (3.2) | Urinary tract infection | 8 (4.5) |
Small bowel obstruction | 18 (3.2) | Disorders of ovary | 10 (2.7) | Influenza | 6 (3.4) |
Urinary tract infection | 17 (3.1) | Small bowel obstruction | 10 (2.7) | Constipation | 5 (2.8) |
Upper respiratory infection | 13 (2.3) | Upper respiratory infection | 9 (2.4) | Gastrointestinal hemorrhage | 5 (2.8) |
Urinary retention | 12 (2.2) | Diverticulitis | 8 (2.1) | NSAP * | 5 (2.8) |
Disorders of ovary | 10 (1.8) | Pyelonephritis | 8 (2.1) | Pneumonia | 5 (2.8) |
GERD ** | 9 (1.6) | Pancreatitis | 7 (1.9) | Upper respiratory infection | 4 (2.2) |
Gastrointestinal hemorrhage | 9 (1.6) | GERD ** | 6 (1.6) | Sepsis | 4 (2.2) |
Influenza | 9 (1.6) | Somatoform disorders | 6 (1.6) | COPD *** | 3 (1.7) |
Pancreatitis | 8 (1.4) | Lower back pain | 5 (1.3) | Fracture rib(s), sternum | 3 (1.7) |
Pyelonephritis | 8 (1.4) | Gastrointestinal hemorrhage | 4 (1.1) | GERD ** | 3 (1.7) |
Constipation | 7 (1.3) | Pregnancy | 4 (1.1) | Aortic aneurysm | 2 (1.1) |
Lower back pain | 7 (1.3) | Constipation | 3 (0.8) | Appendicitis | 2 (1.1) |
Pneumonia | 7 (1.3) | Endometriosis | 3 (0.8) | Epilepsy | 2 (1.1) |
Sepsis | 7 (1.3) | Functional Dyspepsia | 3 (0.8) | Fibrosis and cirrhosis of liver | 2 (1.1) |
350 (63) | 262 (70) | 107 (60) |
Final Diagnosis (D) | Total, n (%) | D Correct at Index Visit, n | D Missed at Index Visit, n |
---|---|---|---|
Cholelithiasis | 8 (13) | 6 | 2 |
Gastroenteritis | 7 (11) | 2 | 5 |
Urinary retention | 4 (6) | 4 | 0 |
NSAP | 3 (6) | 2 | 1 |
Appendicitis | 2 (3) | 1 | 1 |
Constipation | 2 (3) | 1 | 1 |
Disorders of ovary | 2 (3) | 1 | 1 |
Diverticulitis | 2 (3) | 2 | 0 |
Endometriosis | 2 (3) | 2 | 0 |
Food intolerance | 2 (3) | 0 | 2 |
Malignant diseases | 2 (3) | 0 | 2 |
Pyelonephritis | 2 (3) | 2 | 0 |
Urolithiasis | 2 (3) | 1 | 1 |
Others | 23 (37) | 13 | 10 |
63 (100) |
All (n = 3960) | <65 Years (n = 2652) | ≥65 Years (n = 1308) | ||||
---|---|---|---|---|---|---|
Abdominal Pain | No Abdominal Pain | Abdominal Pain | No Abdominal Pain | Abdominal Pain | No Abdominal Pain | |
Hospitalization, n (%) | 170 (35.4) * | 1067 (30.7) | 87 (25.7) ** | 384 (16.6) | 83 (58.9) | 683 (58.5) |
LOS (days), median (Q1, Q3) | 5 (2.5, 9) | 5 (2, 10) | 4 (2, 7) | 4 (2, 9) | 7 (3, 11) | 5 (2, 10) |
ICU, n (%) | 19 (5) | 200 (5.8) | 9 (2.7) | 78 (3.4) | 10 (7.1) | 122 (10.5) |
Mortality (in-hospital), n (%) | 6 (1.3) | 49 (1.4) | 1 (0.3) | 6 (0.3) | 5 (3.6) | 43 (3.7) |
Mortality (30-day), n (%) | 10 (2.2) | 69 (2.1) | 1 (0.3) | 8 (0.4) | 9 (6.6) | 61 (5.4) |
Mortality (1-year), n (%) | 26 (5.8) | 189 (5.8) | 5 (1.6) | 19 (0.9) | 21 (15.3) | 170 (15) |
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Osterwalder, I.; Özkan, M.; Malinovska, A.; Nickel, C.H.; Bingisser, R. Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes. J. Clin. Med. 2020, 9, 899. https://doi.org/10.3390/jcm9040899
Osterwalder I, Özkan M, Malinovska A, Nickel CH, Bingisser R. Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes. Journal of Clinical Medicine. 2020; 9(4):899. https://doi.org/10.3390/jcm9040899
Chicago/Turabian StyleOsterwalder, Isabelle, Merve Özkan, Alexandra Malinovska, Christian H. Nickel, and Roland Bingisser. 2020. "Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes" Journal of Clinical Medicine 9, no. 4: 899. https://doi.org/10.3390/jcm9040899
APA StyleOsterwalder, I., Özkan, M., Malinovska, A., Nickel, C. H., & Bingisser, R. (2020). Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes. Journal of Clinical Medicine, 9(4), 899. https://doi.org/10.3390/jcm9040899