EVALUATION OF GERIATRIC PATIENTS THAT ADMITTED TO THE EMERGENCY DEPARTMENT WITH ACUTE ABDOMINAL PAIN

Year 2022, , 37 - 46, 01.03.2022

Nezih Kavak , Cemil Kavalcı

https://doi.org/10.17343/sdutfd.953443

Abstract

Objective
The goal of the study is to investigate demographic
findings, clinical characteristics, radiological
examination methods, and mortality rate of geriatric
patients (aged 65 and above) with non-traumatic acute
abdominal pain, that were admitted to the emergency
department (ED).
Materials and Methods
2253 patients included in the study were divided by age
as patients aged 65 to 74 years and patients aged 75
years and above. Gender, comorbidity, concomitant
complaints examination findings (tenderness defense,
rebound), radiological examination methods (radiography,
ultrasonography, and computed tomography),
diagnoses, treatments (medical, surgical), discharge,
and mortality rate were compared between these
patients.
Results
Of the patients, 62.3% were female, and the mean
age was 72.2±5.1 years (65-88). While 59.4% of
the patients were in the 65–74 age group, 40.6% of
them were aged 75 years and above. Hypertension,
diabetes mellitus, dementia/Alzheimer's disease,
atrial fibrillation were significantly higher in the aged
65 to 74 years patients (p<0.001). Diarrhea, one
of the concomitant complaints, was significantly
higher in the aged 65 to 74 years patients
(p<0.001). Tenderness, defense, and rebound
were significantly higher in the aged 65 to 74 years
patients (p<0.001). There was no difference between
the age ranges in terms of radiological examination
methods (p=0.434; p=0.321; p=0.634, respectively).
Acute gastroenteritis, nonspecific abdominal pain,
abdominal aortic aneurysm were higher in the aged
65 to 74 years patients, while biliary and biliary tract
diseases, constipation, gastrointestinal tract bleeding,
peptic ulcer, diverticulitis and complications, stomach
perforation, abdominal aortic dissection, and acute
mesenteric ischemia were higher in the aged 75
years and above (p<0.05). There was no difference
between the age groups in terms of treatment
(p=0.478; p=0.182, respectively). The number of
patients who died aged 75 years and above was
significantly higher (p<0.001).
Conclusion
The current study found significant age-related
differences in examination findings, diseases affecting
mortality, and mortality rate in geriatric patients
admitted to ED with acute abdominal pain.

Keywords

Abdominal pain, geriatric patient, emergency department

ACİL SERVİSE AKUT KARIN AĞRISI İLE BAŞVURAN GERİATRİK HASTALARIN DEĞERLENDİRİLMESİ

Abstract

Amaç
Bu çalışmanın amacı acil servise (AS) nontravmatik
akut karın ağrısı ile başvuran 65 yaş ve üzeri geriatrik
hastaların demografik bulgularını, klinik özelliklerini,
radyolojik inceleme yöntemlerini ve mortalite oranlarını
değerlendirmektir.
Gereç ve Yöntem
Çalışmaya dahil edilen 2253 hasta yaş aralıklarına
göre; 65-74 ve 75 yaş ve üzeri olarak ayrıldı. Cinsiyet,
komorbidite, eşlik eden şikayetler, muayene bulguları
(hassasiyet, defans, rebound), radyolojik inceleme
yöntemleri (radyografi, ultrasonografi ve bilgisayarlı
tomografi), tanılar, tedaviler (tıbbi, cerrahi), taburculuk
ve mortalite oranları karşılaştırıldı.
Bulgular
Hastaların %62.3'ü kadın olup, yaş ortalaması
72.2±5.1 yıl (65-88) idi. Hastaların %59,4'ü 65-74
yaş aralığında iken, %40,6'sı 75 yaş ve üzerinde idi.
Hipertansiyon, diabetes mellitus, demans/Alzheimer
hastalığı, atriyal fibrilasyon 65-74 yaş aralığındaki
hastalarda anlamlı olarak daha yüksekti (p<0,001).
Eşlik eden yakınmalardan biri olan ishal, 65-74 yaş
aralığındaki hastalarda anlamlı olarak daha yüksek idi
(p<0,001). Hassasiyet, defans ve rebound, 65-74 yaş
aralığındaki hastalarda anlamlı olarak daha yüksek
idi. (p<0.001). Radyolojik inceleme yöntemleri açısından
yaş aralıkları arasında fark yok idi (sırasıyla;
p=0,434; p=0,321; p=0,634). 65-74 yaş aralığındaki
hastalarda akut gastroenterit, nonspesifik karın ağrısı,
abdominal aort anevrizması, 75 yaş ve üzerinde safra
kesesi ve yollarına ait hastalıklar, konstipasyon, gastrointestinal
sistem kanaması, peptik ülser, divertikülit
ve komplikasyonları, mide perforasyonu, abdominal
aorta diseksiyonu ve akut mezenterik iskemi tanıları
anlamlı yüksek idi (p<0,05). Tedavi açısıdan yaş
aralıkları arasında anlamlı fark saptanmadı (sırasıyla;
p=0,478; P=0,182). 75 yaş ve üzerinde ölen hasta
sayısı anlamlı olarak daha yüksek idi (p<0,001).
Sonuç
Mevcut çalışma, AS’e akut karın ağrısı ile başvuran
geriatrik hastalarda muayene bulguları, mortaliteyi etkileyen
hastalıklar ve mortalite oranlarında yaşa bağlı
anlamlı farklılıklar bulmuştur.

Keywords

Karın ağrısı, geriatrik hasta, acil servis

References

• 1. Gans SL, Pols MA, Stoker J, Boermeester MA; expert steering group. Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg. 2015;32(1):23-31
• 2. Caporale N, Morselli-Labate AM, Nardi E, Cogliandro R, Cavazza M, Stanghellini V. Acute abdominal pain in the emergency department of a university hospital in Italy. United European Gastroenterol J. 2016 Apr;4(2):297-304. doi: 10.1177/2050640615606012.
• 3. Ellis G, Marshall T, Ritchie C. Comprehensive geriatric assessment in the emergency department. Clin Interv Aging. 2014;9:2033-43.
• 4. Henden Çam P, Baydin A, Yürüker S, Erenler AK, Şengüldür E. Investigation of Geriatric Patients with Abdominal Pain Admitted to Emergency Department. Curr Gerontol Geriatr Res. 2018;2018:9109326.
• 5. Fagbohun CF, Toy EC, Baker I. The evaluation of acute abdominal pain in the elderly patient. BJPCUfOG, 1999; 6(6):181-5.
• 6. Gardner RL, Almeida R, Maselli JH, Auerbach A. Does gender influence emergency department management and outcomes in geriatric abdominal pain? J Emerg Med. 2010 Sep;39(3):275-81.
• 7. Leuthauser A, McVane B. Abdominal Pain in the Geriatric Patient. Emerg Med Clin North Am. 2016;34(2):363-75.
• 8. Samaras N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: a review. Ann Emerg Med. 2010;56(3):261-9.
• 9. Durukan P, Çevik Y, Yıldız M. Acil servise karın ağrısı ile başvuran yaşlı hastaların değerlendirilmesi. Turkish journal of geriatrics 2005;8:111-14.
• 10. Mert D, Durak V, Özdemir F, Armağan E. Acil Servise Karın Ağrısı Şikayeti ile Başvuran 45-64 Yaş ile 65 Yaş ve Üzeri Hastaların Karşılaştırılması ve Tanılarının Fizyolojik Değişikliklerle İlişkisinin Değerlendirilmesi. Uludağ Tıp Derg. 2017; 43(1): 7-12.
• 11. Bilgili MA, Öncü MR. Evaluation of Geriatric Patients Applying to the Emergency Department. Van Med J. 2021; 28(1): 77-83.
• 12. Pappas A, Toutouni H, Gourgiotis S, Seretis C, Koukoutsis I, Chrysikos I, et al. Comparative approach to non-traumatic acute abdominal pain between elderly and non-elderly in the emergency department: a study in rural Greece. J Clin Med Res. 2013;5(4):300-4.
• 13. Lewis LM, Banet GA, Blanda M, Hustey FM, Meldon SW, Gerson LW. Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. J Gerontol A Biol Sci Med Sci. 2005;60(8):1071-6. doi: 10.1093/gerona/60.8.1071.
• 14. Laurell H, Hansson LE, Gunnarsson U. Acute abdominal pain among elderly patients. Gerontology. 2006;52(6):339-44.
• 15. Bedel C, Tomruk Ö. Bir Universite Acil Servisine Başvuran Geriatrik Hastaların Ozellikleri. SDU Tıp Fakültesi Dergisi. 2018;25(4):393-99.
• 16. Hustey FM, Meldon SW, Banet GA, Gerson LW, Blanda M, Lewis LM. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med. 2005;23(3):259-65.
• 17. Pérez-Hernández JL, Teuffer-Carrion LT, Díaz-Aldana EV, Hernández- Guerrero S, Morón-Ventura P, Nieves-Durán M, et al. Dolor abdominal agudo en pacientes geriátricos evaluados en el servicio de urgencias en un hospital de tercer nivel [Acute abdominal pain in elderly patients evaluated in the emergency department at a tertiary level]. Rev Gastroenterol Mex. 2010;75(3):261-6.
• 18. Dündar ZD, Ayrancı MK. Karın Ağrısı Şikayetiyle Acil Servise Başvuran Geriatrik Hastaların Demografik Özelliklerinin ve Prognozlarının Değerlendirilmesi. Selcuk Med 2021;37(1): 45-51.
• 19. Magidson PD, Martinez JP. Abdominal Pain in the Geriatric Patient. Emerg Med Clin North Am. 2016;34(3):559-74. doi: 10.1016/j.emc.2016.04.008.
• 20. Öncül MV, Dağar S, Emektar E, Çorbacıoğlu ŞK, Aytar H, Çevik Y. Effects of Systemic Inflammatory Parameters on Mortality in Elderly Patients Admitted to Emergency Department with Abdominal Pain. İstanbul Med J 2019; 20(2):125-9.
• 21. Velissaris D, Karanikolas M, Pantzaris N, Kipourgos G, Bampalis V, Karanikola K, Fafliora E, Apostolopoulou C, Gogos C. Acute Abdominal Pain Assessment in the Emergency Department: The Experience of a Greek University Hospital. J Clin Med Res. 2017;9(12):987-993. doi: 10.14740/jocmr3206w.
• 22. Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician. 1;74(9):1537-44.
• 23. Spangler R, Van Pham T, Khoujah D, Martinez JP. Abdominal emergencies in the geriatric patient. Int J Emerg Med. 2014;7:43. doi:10.1186/s12245-014-0043-2.
• 24. Kalyani RR, Corriere M, Ferrucci L. Age-related and disease- related muscle loss: the effect of diabetes, obesity, and other diseases. Lancet Diabetes Endocrinol. 2014;2(10):819- 829. doi:10.1016/S2213-8587(14)70034-8.
• 25. Miettinen P, Pasanen P, Lahtinen J, Alhava E. Acute abdominal pain in adults. Ann Chir Gynaecol. 1996;85(1):5-9.
• 26. Lamsal D, Bhandari J. Status of Geriatric Patients with Abdominal Pain Presented To Emergency Department. Journal of Chitwan Medical College, 2019;9(2), 90-6.
• 27. Torrance AD, Powell SL, Griffiths EA. Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med. 2015;7:55-68. doi:10.2147/OAEM.S68324.
• 28. Dumic I, Nordin T, Jecmenica M, Stojkovic Lalosevic M, Milosavljevic T, Milovanovic T. Gastrointestinal Tract Disorders in Older Age. Can J Gastroenterol Hepatol. 2019:6757524. doi: 10.1155/2019/6757524.
• 29. Omari AH, Khammash MR, Qasaimeh GR, Shammari AK, Yaseen MK, Hammori SK. Acute appendicitis in the elderly: risk factors for perforation. World J Emerg Surg. 2014;9(1):6.
• 30. Gardner CS, Jaffe TA, Nelson RC. Impact of CT in elderly patients presenting to the emergency department with acute abdominal pain. Abdom Imaging. 2015;40(7):2877-82.
• 31. Chang CC, Wang SS. Acute abdominal pain in the elderly. International Journal of Gerontology 2007;1(2):77-82.