Standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain.
BACKGROUND
The aim of the present study was to investigate the efficacy and safety of standard outpatient re-evaluation for patients who are not admitted to the hospital after emergency department surgical consultation for acute abdominal pain.


METHODS
All patients seen at the emergency department between June 2005 and July 2006 for acute abdominal pain were included in a prospective study using a structured diagnosis and management flowchart. Patients not admitted to the hospital were given appointments for re-evaluation at the outpatient clinic within 24 h. All clinical parameters, radiological results, diagnostic considerations, and management proposals were scored prospectively.


RESULTS
Five-hundred patients were included in this analysis. For 148 patients (30%), the final diagnosis was different from the diagnosis after initial evaluation. Eighty-five patients (17%) had a change in management after re-evaluation, and 20 of them (4%) were admitted to the hospital for an operation. Only 6 patients (1.2%) had a delay in diagnosis and treatment, which did not cause extra morbidity.


CONCLUSIONS
Standard outpatient re-evaluation is a safe and effective means of improving diagnostic accuracy and helps to adapt management for patients that are not admitted to the hospital after surgical consultation for acute abdominal pain at the emergency department.
Toorenvliet
Boudewijn R
BR
Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. br.toorenvliet@tiscali.nl
Bakker
Rutger F R
RF
Flu
Hans C
HC
Merkus
Jos W S
JW
Hamming
Jaap F
JF
Breslau
Paul J
PJ
D000006:Abdomen, Acute / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D003937:Diagnosis, Differential; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D014463:Ultrasonography; D055815:Young Adult