Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department.
OBJECTIVE
To determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain.


METHODS
A retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Altiplano Health Area (Murcia) was performed. In our study we considered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed diagnoses, which were retrospectively assessed by an external radiologist who was unaware of the patient s final diagnosis.


RESULTS
Our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appendicitis was the main cause (approx. 25%), followed by cholecystitis (10%). We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC) and a diagnosis with cholecystitis. This location was also significant for acute appendicitis (up to 74%). Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphy s sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively.


CONCLUSIONS
a) Anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b) ultrasound scans offer a low diagnostic agreement index for appendicitis; and c) laparoscopy may prove useful for diagnosis, and is also a possible treatment for acute abdominal pain despite its low diagnostic efficiency.
Department of Emergency of Yecla, Murcia, Spain.
J A
JA
Navarro Fernández
P J
PJ
Tárraga López
J A
JA
Rodríguez Montes
M A
MA
López Cara
D000006:Abdomen, Acute / Q000175:diagnosis* / Q000209:etiology; D018784:Abdominal Abscess / Q000175:diagnosis; D000328:Adult; D001064:Appendicitis / Q000175:diagnosis; D002764:Cholecystitis / Q000175:diagnosis / Q000000981:diagnostic imaging; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000175:diagnosis; D010535:Laparoscopy; D007813:Laparotomy; D016013:Likelihood Functions; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D015588:Observer Variation; D010808:Physical Examination; D011237:Predictive Value of Tests; D014463:Ultrasonography