Characteristics, Interventions, and Outcomes for Patients Presenting to the Emergency Department With Abdominal Pain

We sought to characterize patients presenting to emergency departments (EDs) with abdominal pain and to validate risk categories defined by the Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-2) for low-risk recurrent abdominal pain.

We conducted a retrospective cohort study of patients presenting with abdominal pain between November 2019 and November 2023 across 21 EDs in Arizona, the Midwest, and Florida. Patients were categorized per GRACE-2 into recurrent and non-recurrent pain as well as low- and high-risk groups. Primary outcomes included 72-h returns and mortality at 30 and 90 days.

The study included 162,494 visits (112,896 unique patients; median age 46 years; 61.2% female). Among these, 4.3% had low-risk recurrent abdominal pain. Patients with recurrent and non-recurrent low-risk pain had similar ED length of stay and discharge rates to each other, compared to patients with high-risk pain who had longer length of stay and lower discharge rates. At 30 days after the ED encounter, patients with low-risk recurrent abdominal pain had similar mortality to patients with low-risk non-recurrent pain (0.4% vs. 0.3%; adjusted RR = 1.31, 95% CI: 0.85-2.03), while they had significantly lower mortality than patients with high-risk recurrent abdominal pain (0.4% vs. 2.3; adjusted RR = 3.14, 95% CI: 2.02-4.89).

This study highlights the heterogeneity in patients presenting to the ED with abdominal pain. Among these patients, those with low-risk recurrent pain demonstrated similar lengths of stay, discharges, and mortality rates to those with low-risk non-recurrent pain and less favorable lengths of stay, discharges, and mortality rates compared to those with any high-risk features. These findings suggest that low- and high-risk features may be more useful than recurrent or non-recurrent pain in identifying patients who could benefit from more robust ED evaluations.