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Etiology and Clinical Course of Abdominal Pain in Senior Patients: A Prospective, Multicenter Study

¹ Washington University, St. Louis, Missouri.
² Northeastern Ohio Universities College of Medicine, Akron.
³ Cleveland Clinic Foundation, Ohio.
⁴ MetroHealth, Cleveland, Ohio.

Correspondence: Address correspondence to Lawrence M. Lewis, MD, Washington University School 8072, St. Louis, MO 63110. E-mail: lewisl{at}msnotes.wustl.edu

Background. The authors describe the epidemiology and clinical course of older persons examined in emergency departments (EDs) for abdominal pain.

Methods. This was a prospective, multicenter, observational study of older persons (60 years) examined in participating EDs for nontraumatic abdominal pain. Medical records were reviewed for demographics, ED diagnoses, findings of radiographic imaging, disposition, operative procedures, length of hospitalization, and final diagnoses. Patients were interviewed at 2 weeks to determine clinical course, final diagnoses, and mortality status. The authors compared ED diagnoses with final diagnoses, reporting the percentage change in aggregate and for the 12 most common diagnoses.

Results. Of 360 patients (mean age, 73.2 ± 8.8 years; 66% women; 51% white) who met selection criteria, 209 (58%) were admitted to the hospital and 63 (18%) required surgery or an invasive procedure. For patients with complete follow-up information (n = 337), 37 (11%) had repeated ED visits and 23 (7%) were readmitted to the hospital. The case-fatality rate was 5%. Leading causes of abdominal pain were nonspecific (14.8%), urinary tract infection (8.6%), bowel obstruction (8%), gastroenteritis (6.8%), and diverticulitis (6.5%). The ED and final diagnoses matched 82% of the time. Older patients had higher mortality rates (odds ratio, 4.4; 95% confidence interval, 1.4–14) and lower diagnostic concordance rates (76% vs 87%; p =.01). Study limitations include inability to enroll all eligible persons and possible inaccuracies in participant-reported follow-up interviews.

Conclusions. Abdominal pain in older patients should be investigated thoroughly as, in this study, nearly 60% of patients were hospitalized, 20% underwent operative or invasive procedures, 10% had return ED visits, and 5% died within a 2-week follow-up period.