[Epidemiology, initial diagnosis, and therapy of unexplained abdominal pain in the emergency department]

Abdominal pain is one of the most common symptoms of patients who present to the emergency department (ED). The aim of this study was to collect current epidemiological data, the frequency of these findings, and the measures that derived from them.

We performed a retrospective analysis in the period between January 1 and June 30, 2016, including all patients who presented to the ED of the Caritas Hospital St. Josef in Regensburg (teaching hospital with an academic urology and gynecology department, about 32,000 patients in the ED per year) and were categorized as "abdominal pain in adults" using the Manchester Triage System (MTS).

The study population consisted of 1417 patients (9.8% of all ED patients). The admission rate was 48.2%. Vomiting and fever as concomitant symptoms made hospitalization more likely (p = 0.00). Almost half of the patients had nonspecific abdominal pain (28.2%), gynecological causes (13.2%), or suspected acute appendicitis (6.7%). In all, 10% of patients received an abdominal CT investigation; 73% of the patients presented in the time from 08:00-20:00 h, and more frequently on weekdays (74.2%). Of these patients, 6.4% returned after discharge because of persisting or worsening symptoms. Finally, 58.6% of outpatients and 77.5% of inpatients received further treatment recommendations for new pharmacologic therapy (e.g., analgesics, proton pump inhibitors, antibiotics).

A variety of epidemiological data of our collective could be analyzed, which should be transferable to many other German EDs. The MTS shows a high reliability in terms of conversion rate in abdominal pain; despite comprehensive emergency diagnostics, a relevant proportion of complaints remain unclear.