Patients Presenting to the Emergency Unit with Gynaecological Lower Abdominal Pain, with and without Pathological Clinical Findings - Service Utilisation, Pain History, Implications.
Introduction:Few studies have evaluated the utilisation of emergency gynaecological services, although lower abdominal pain (LAP) is one of the most common symptoms prompting emergency presentation. Although such pain may be caused by potentially life-threatening gynaecological diseases, very often no clinical cause is found. The aim of this study was to describe the characteristics of emergency presentations in order to enable quicker identification of real emergencies in routine clinical practice.Materials and Methods:Standardised, so-called first aid cards of 1066 consecutive patients with LAP presenting acutely to one emergency unit were analysed in this retrospective, cross-sectional study.Results:Over one third of cases did not constitute actual medical emergencies on objective criteria, with investigations yielding "no pathological findings". Parameters were identified that more often lead to hospital admission, e.g. palpation of a mass/resistance or at least one pathological ultrasound finding. In addition, it was found that symptoms of longer duration (average 8 days), and not only acute LAP, were also often experienced by patients as emergencies.Conclusion:A diagnosis of "no pathological findings", which was common in our study, suggests a subjective experience of an emergency from the patient's point of view, although the possibility of unrecognised pathology has to be borne in mind. Apart from functional disorders, the origins of symptoms may include psychosomatic causes and psychosocial problems, which cannot be further defined in the emergency care setting. Also, the phenomenon of increased utilisation of emergency services parallel to the assumed opening hours of routine outpatient care facilities must be seen in a critical light.
Frauenklinik, Martin-Luther-Krankenhaus, Berlin.
F
F
Siedentopf
Vivantes, Auguste-Viktoria-Klinikum, Klinik für Neurologie, Berlin.
E
E
Wowro
Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Mitte, Arbeitsbereich Notfallmedizin/Rettungsstellen mit Aufnahmestationen und CPUs, Berlin.
M
M
Möckel
Fertility Center Berlin, Berlin.
H
H
Kentenich
Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Gynäkologie, Berlin.
M
M
David
emergency management; gynaecology; lower abdominal pain; women
JNMA J Nepal Med Assoc. 2013 Jan-Mar;52(189):213-6
23591298
J Womens Health (Larchmt). 2008 Mar;17(2):269-77
18321178
Langenbecks Arch Chir. 1996;381(2):65-74
8649127
Dtsch Med Wochenschr. 2009 Feb;134(6):246-50
19180416
Am J Emerg Med. 1995 May;13(3):301-3
7755822
Arch Iran Med. 2013 Jul;16(7):397-400
23808776
Z Gastroenterol. 2010 Jun;48(6):696-706
20517808
Zentralbl Gynakol. 2001 Jan;123(1):10-7
11385905
Emerg Med Int. 2014;2014:320926
24971177
Obstet Gynecol. 1998 Jun;91(6):1007-12
9611014
BMJ. 2006 Apr 1;332(7544):749-55
16484239
J Psychosom Res. 2001 Jul;51(1):361-7
11448704
Dtsch Arztebl Int. 2010 Apr;107(15):261-7
20458367
World J Gastroenterol. 2014 Apr 14;20(14):4043-9
24744594
J Ultrasound Med. 2013 Jul;32(7):1181-7
23804340
Ann R Coll Surg Engl. 1995 May;77(3):193-7
7598417
J Psychosom Res. 2009 May;66(5):363-77
19379952
Am J Emerg Med. 2011 Sep;29(7):711-6
20825873
J Clin Med Res. 2013 Aug;5(4):300-4
23864920
Dtsch Arztebl Int. 2012 Nov;109(47):803-13
23248710
Gynecol Obstet Invest. 2001;51(1):55-9
11150877
Natl Health Stat Report. 2010 Aug 6;(26):1-31
20726217
Ann Surg. 2006 Dec;244(6):881-6; discussion 886-8
17122613
J Obstet Gynaecol Can. 2005 Aug;27(8):781-826
16287011