الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
AAP is a very common presentation to emergency department. It is vital that the emergency physician has an understanding and be familiar with the presentations of common diseases that cause AAP. Patients with AAP are a heterogeneous group that consumes a great deal of a surgical department’s resources. To streamline efficiency and provide maximum cost effectiveness it would be of benefit to identify clinical and laboratory parameters in patients admitted with AAP that would indicate no significant intra-abdominal pathology and thereby encourage early discharge back to the community.
The aim of this work was to assess and compare the diagnostic value of different variables including clinical presentation, physical examination, and laboratory findings in patients with AAP to determine which of these variables was associated with a specific surgical or medical abdominal pathology, and therefore identification of those who had no definitive diagnosis i.e. NSAP who could be either admitted short term for observation or reassured and discharged for outpatient management.
The study is based on 302 patients who had been admitted for AAP to the the ED of Alexandria University Hospital over a period of 6 months from 1st September 2009 to 28th February 2010. Final diagnosis was determined by emergency medical professionals and patients were classified as non-specific abdominal pain (NSAP) and specific abdominal pain (SAP).
6. Non-specific abdominal pain (NSAP) group:
Eighty six of AAP cases included in our study were diagnosed as NSAP according to the following criteria:
• Non-specific findings on clinical examination and baseline investigations.
• Exclusion of surgical or medical pathology after history, physical examination, and laboratory and radiological investigations.
• Relief or improvement of pain on discharge.
7. Specific abdominal pain (SAP) group:
Two hundred and sixteen of AAP cases included in our study identified a specific medical or surgical abdominal pathology.
Patients were examined by the admitting emergency and surgical team after taking a thorough history, Relevant points in the history included the patient’s gender, age, history of similar pain, duration of pain, site of pain, character of pain, severity of pain, radiation of pain, loss of appetite, nausea, vomiting, change in bowel habit, and urinary or genital symptoms.
Factors in the clinical examination that were considered of significant contribution to the final diagnosis included temperature, pulse rate, respiratory rate, systolic BP, abdominal distension, abdominal tenderness, abdominal guarding, and bowel sounds .
White blood cell (WBC) count, percentage of neutrophils, and the level of Hemoglobin (Hb) were measured.
Data was collected prospectively on structured data sheets. Patients were followed up with further investigations that included ultrasound scan, CT scan and diagnostic laparotomy as was clinically indicated to ascertain the final diagnosis. All patients were admitted for observation or surgery if indicated.
The median age was 36 years (range 16-69). The male: female ratio was 0.75 (n=130/172).
The most frequent final diagnoses at the emergency department were NSAP in 86 (26.6%) patients, appendicitis in 58 (18.4%) and gall bladder disease in 44 (14%) patients. Two less common but still important causes of abdominal pain were ischemic bowel and inflammatory bowel disease, which accounted for 2.2% and 2.4% of final diagnoses, respectively.
Analysis was performed to evaluate the relative contribution and specificity of each individual factor to a definitive final diagnosis that led to identification those who had no definitive diagnosis. The data analysed using SPSS® version 17. Univariate analysis was performed using simple linear regression; multivariate analysis was performed using logistic regression analysis.
Univariate analysis showed important factors that predict acute specific surgical or medical abdominal pathology are age (p = 0.006), history of similar pain (p = 0.002), aggravation on movement (p = 0.034), anorexia (p = 0.002), (p = 0.004), pulse rate (p = 0.008), respiratory rate (p = 0.013), temperature (p