Abdominal pain in the emergency department: 50 years on

Emergency Department (ED) patients with abdominal pain continue to represent a diagnostic challenge. This study of demographics, evaluation, and outcomes provides a look at stability and change over a 50-year span at a single institution.

The current study is the fourth version of this exercise, marking the 50th anniversary of the first examination. The charts of 1000 adult patients presenting to a tertiary care ED in 2022 with a chief complaint of abdominal pain were reviewed. Data extracted included demographics, diagnosis, disposition, and use of imaging and laboratory testing. Where possible, comparison between this study and the previous studies was performed.

The results demonstrated considerably increased use of computed tomography (CT) (+69 %) and ultrasound (+32 %) and a reduction in abdominal radiographs (-68 %) over the past 15 years. Prolonged evaluation time, length of stay, and higher charges accompanied this pattern of increased imaging. Notable findings included continued low frequency of missed surgical illness relative to 1972, but minimal change in the number of patients (~29 %) hospitalized.

Over a 50-year span, ED evaluation of abdominal pain has become more effective at diagnosing acute surgical illness, but less efficient and more costly. The percentage of patients hospitalized has been remarkably stable.