Acute Abdominal Pain Management in the Emergency Department: Surgical or Non-Surgical Abdominal Pain

Yıl 2021, , 224 - 235, 05.06.2021

Nuray Aslan , Ahmet Baydin , Murat Yücel Yusuf Yurumez , Bilge Ercan

https://doi.org/10.26453/otjhs.849297

Öz

Objective: In this study, it was aimed to compare surgical (SAP) and non-surgical abdominal pain (NSAP) in patients admitted to the emergency department (ED) with abdominal pain.
Materials and Methods: This study was carried out prospectively with 200 patients with SAP and NSAP. The demographic characteristics, clinical presentations, laboratory analyzes, imaging methods, consultations and patient care costs of the patients were examined.
Results: The mean age of the study group was 50.8±20.1 years and 52% of the patients were found to have SAP. In SAPcases, patients aged 75 years and above were in the first place, sensitivity-defense and rebound association and white blood cell elevation with an average of 15.27±4.10 thousand / UL were detected in physical examination. It was determined that the percentage of agreement between the preliminary diagnoses and laboratory findings made after the history and physical examination and evaluation by the AS physicians and the final diagnoses made after the radiological imaging methods was 71.7. It was found that the duration of stay in the ED and the cost were high in cases with SAP, elderly patients and those who requested consultation.
Conclusion: Anamnesis and physical examination should definitely be done in patients who apply to AD with abdominal pain, and advanced imaging methods should be requested in the early period, especially in patients with SAP in order to accelerate the process and reduce costs. However, additional studies are needed to support this result.

Anahtar Kelimeler

Abdominal pain, emergency service, surgery, cost

Acil Serviste Akut Karın Ağrısı Yönetimi: Cerrahi Ya Da Cerrahi Olmayan Karın Ağrıları

Öz

Amaç: Bu çalışmada acil servise (AS) karın ağrısı nedeni ile başvuran hastalarda cerrahi (CNKA) ve cerrahi nedenli olmayan karın ağrılarının (CNOKA) karşılaştırılması amaçlanmıştır.
Materyal ve Metod: Bu çalışma prospektif olarak CNKA ve CNOKA olan 200 hasta ile gerçekleştirildi. Hastaların demografik özellikleri, klinik prezantasyonları, laboratuvar analizleri, görüntüleme yöntemleri, konsültasyonlar ve hasta bakım maliyetleri incelenmiştir.
Bulgular: Çalışma grubunun ortalama yaşı 50,8±20,1 yıl ve hastaların %52’sinin CNKA’sı olduğu tespit edildi. CNKA olgularda 75 yaş ve üzeri hastaların ilk sırada yer aldığı, fizik muayenede hassasiyet-defans ve rebound birlikteliği ve ortalama 15,27±4,10 bin/UL ile beyaz küre yüksekliği tespit edildi. AS doktorlarınca öykü ve fizik muayene ile değerlendirme sonrasında konulan ön tanıları ve laboratuvar bulguları ile radyolojik görüntüleme yöntemleri sonrasında konulan son tanıların uyum yüzdesinin 71,7 olduğu saptandı. CNKA’lı olgularda, yaşlı hastalarda ve konsültasyon istenenlerde AS kalış süresi ve maliyetin yüksek olduğu saptandı.
Sonuç: AS’lere karın ağrısı ile başvuran hastalarda anamnez ve fizik muayene mutlaka yapılmalı, sürecin hızlandırılması ve maliyetlerin azaltılmasına yönelik olarak özellikle CNKA düşünülen hastalarda ileri görüntüleme yöntemleri erken dönemde istenmelidir. Ancak bu sonucu destekleyecek ilave çalışmalar yapılmasına ihtiyaç vardır.

Anahtar Kelimeler

Acil servis, cerrahi, karın ağrısı, maliyet

Kaynakça

• Natesan S, Lee J. Evidence-based medicine approach to abdominal pain. Emerg Med Clin North Am. 2016;34(2):165-190. doi:10.1016/j.emc.2015.12.008
• de Burlet K, Lam A. Acute abdominal pain-changes in the way we assess it over a decade. N Z Med J. 2017;130:39-44.
• Kachalia A, Gandhi TK. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007;49(2):196-205.
• Kacprzyk A, Stefura T, Chłopaś K, etc al. Analysis of readmissions to the emergency department among patients presenting with abdominal pain. BMC Emerg Med. 2020;12;20(1):37. doi:10.1186/s12873-020-00334-x
• Chanana L, Jegaraj AM, Kalyaniwala , etc al. Clinical profile of non-traumatic acute abdominal pain presenting to an adult emergency department. J Family Med Prim Care. 2015;4(3):422-427. doi:10.4103/2249-4863.161344
• Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Family Physician. 2008;77(7):971-978.
• Lameris W, van Randen A. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: Diagnostic accuracy study. BMJ. 2009;338:b2431. doi: https://doi.org/10.1136/bmj.b2431
• Lameris W, van Randen A. Optimization of diagnostic imaging use in patients with acute abdominal pain OPTIMA: Design and rationale. BMC Emerg Med. 2007;7:9-15. doi:10.1186/1471-227X-7-9
• Ertekin C, Güloğlu R, Taviloğlu K. Akut karın hastasına yaklaşım: In: Acil Cerrahi, ed. Kalaycı G. 2nd ed. Nobel Tıp Kitabevi; 2002;195-216.
• Abdolrazaghnejad A, Rajabpour-Sanati A. The role of ultrasonography in patients referring to the emergency department with acute abdominal pain. Adv J Emerg Med. 2019;3(4):e43. doi:10.22114/ajem.v0i0.152
• Aygencel G, Yılmaz U. Acil serviste karın ağrısını değerlendirmenin maliyeti. Gazi Medical Journal. 2009:20(1):7-12.
• Al-Mulhim AA. Emergency general surgical admission. Prospective institutional experience in non-traumatic acute abdomen: implications for education, training and service. Sauudi Med J. 2006;27(11):1674-1683.
• Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. American Family Physician. 2006;74:1537-1544.
• Leuthauser A, McVane B. Abdominal pain in the geriatric patient. Emerg Med Clin North Am. 2016;34(2):363-375. doi:10.1016/j.emc.2015.12.009
• Magidson PD, Martinez JP. Abdominal pain in the geriatric patient. Emerg Med Clin North Am. 2016;34(3):559-574. doi:10.1016/j.emc.2016.04.008
• Laurell H, Hansson LE, Gunnarsson U. Acute abdominal pain among elderly patients. Gerontology. 2006;52:339-344.
• Abbas SM, Smithers T, Truter E. What clinical and laboratory parameters determine significant intra abdominal pathology for patients assessed in hospital with acute abdominal pain? World Journal of Emergency Surgery. 2007;2:26-30. doi:10.1186/1749-7922-2-26
• Burg MD, Francis L. Acute abdominal pain in the elderly. Ann Emerg Med. 1990;19(12):1383-1389. doi:10.1016/s0196-0644(05)82602-2
• Masneri D.A, O’Brein. Acute abdominal pain. In: Emergency Medicin: A Comprehensive Study Guide, ed. Tintinalli E.J, 9th ed. New York: McGraw-Hill; 2019:473-481.
• Staniland JR, Ditchburn J, de Dombal FT. Clinical presentation of the acute abdomen: Study of 600 patients. Br Med J. 1972;3:393-398.
• Besinger B,Stehman C.R. Pankreatitis and cholecystitits. In: Emergency Medicine: A Comprehensive Study Guide, ed. Tintinnalli JE, John Ma. O, Yealy M.D. 9th ed. New York: McGraw-Hill; 2019:508-516.
• Gans SL, Atema JJ, Stoker J, ve ark. C-reactive protein and white blood cell count as triage test between urgent and nonurgent conditions in 2961 patients with acute abdominal pain. Medicine (Baltimore). 2015;94(9):e569. doi: 10.1097/MD.0000000000000569
• Gans SL, Pols MA, Stoker J, et al. Guideline fort he diagnostic pathway in patients with acute abdominal pain. Dig Surg. 2015:32(1):23-31. doi:10.1159/000371583
• Flasar MH, Cross R, Goldberg E. Acute abdominal pain. Prim Care: Clin in Office Pract. 2006;33:659-684. doi:10.1016/j.pop.2006.06.004
• Özgüç H, Çakın N. Akut nonspesifik karın ağrılı olguların 1 yıllık prognozları, semptom ve bulgularının tanısal doğruluğu. Ulusal Travma Acil Cerrahi Dergisi. 2008;14:118-124.
• Claessen JJM, van Es JM, Boermeester MA. Abdominal pain. Ned Tijdschr Geneeskd. 2019;20;163:D3052.