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Efficacy of scheduled return visits for emergency department patients with non-specific abdominal pain
  1. Annemieke E Boendermaker1,
  2. Constant W Coolsma1,
  3. Marloes Emous2,
  4. Ewoud ter Avest1,3
  1. 1Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  2. 2Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  3. 3HEMS, Kent, Surrey and Sussex Air Ambulance Trust, Redhill, Surrey, UK
  1. Correspondence to Dr Ewoud ter Avest, Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden 8934 AD, The Netherlands; teravestewoud{at}hotmail.com

Abstract

Introduction Many patients presenting with abdominal pain to emergency departments (EDs) are discharged without a definitive diagnosis. For these patients, often designated as having non-specific abdominal pain, re-evaluation is often advocated. We aimed to investigate how often re-evaluation changes the diagnosis and clinical management and discern factors that could help identify patients likely to benefit from re-evaluation.

Methods This was a retrospective study conducted in the Netherlands between 1 January 2014 and 31 December 2015 of patients asked to return to the ED after an initial presentation with acute non-traumatic abdominal pain. The primary outcome was a clinically relevant change in treatment (surgery, endoscopy during admission and/or hospitalisation) and diagnosis at ED re-evaluation within 30 hours.

Results During the 2-year study period, 358 ED patients with non-specific abdominal pain were scheduled for re-evaluation. Of these, 14% (11%–18%)) did not present for re-evaluation. Re-evaluation resulted in a clinically relevant change in diagnosis and treatment in, respectively, 21.3% (17%–29%)) and 22.3% (18%–27%)) of the subjects. Of the clinical, biochemical and radiological factors available at the index visit, C reactive protein (CRP) at the index visit predicted a change in treatment (CRP >27 mg/L likelihood ratio (LR)+ 1.69 (1.21–2.36)), while an increase in CRP of >25 mg/L between index and re-evaluation visit (LR+ 2.85 (1.88–4.32)) and the conduct of radiological studies at the re-evaluation visit were associated with changes in treatment (LR+ 3.05 (2.41–3.86)).

Conclusion Re-evaluation within 30 hours for ED patients discharged with non-specific abdominal pain resulted in a clinically relevant change in diagnosis and therapy in almost one-quarter of patients. Elevated CRP at the index visit might assist in correctly identifying patients with a greater likelihood of needing treatment in follow-up, and a low threshold for radiological studies should be considered during re-evaluation.

  • abdomen- non trauma
  • clincial management
  • effectiveness
  • emergency care systems, emergency departments
  • safety

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Footnotes

  • Contributors All authors fulfilled the ICMJE criteria for authorship. EtA conceived the study. AEB, CWC and EtA acquired and interpreted the data. AEB, EtA and ME drafted the manuscript. All authors revised the manuscript critically and gave final approval to submission of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Regionale toetsingscommissie patientgebonden onderzoek (RTPO) Leeuwarden, protocol number 1015.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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