Standardized Exam of the Abdomen Protocol Through Telemedicine in the Emergency Department

Abdominal pain is a common emergency department (ED) presentation, and virtual assessment of such complaints remains a challenge due to the limitations of remote physical examination. The standardized exam of the abdomen protocol (SEAP) was developed to guide patients in performing a self-abdominal examination during telemedicine consultations. We aimed to evaluate agreement between patient-performed abdominal self-examinations using the SEAP and physician-performed abdominal examinations.

We conducted a prospective, single-center study at the American University of Beirut Medical Center ED in Lebanon from August 2023-August 2024. Adult patients who presented with abdominal pain and met the inclusion criteria were enrolled. Each patient performed a video-guided abdominal self-examination by following a brief instructional video (SEAP). The SEAP was developed by an emergency medicine faculty at our institution using pre-established abdominal examination principles and clinical practice frameworks. The protocol was translated into a structured, two-minute instructional video. Blinded abdominal examinations were then performed by an emergency medicine resident and an attending physician. The primary outcome was agreement in abdominal tenderness across seven predefined regions, assessed using the Cohen kappa coefficient. Patient experience and feasibility measures were also collected.

We included a total of 103 patients. Agreement between patient-performed and physician-performed examinations was slight to fair across six of the seven abdominal regions (κ range, .13-.41). The highest agreement was observed in the right lower quadrant, with fair agreement between patients and residents (κ = .47; 95% CI, 0.30-0.64) and patients and attending physicians (κ = .36; 95% CI, 0.18-0.53). Agreement in the remaining regions, including the upper quadrants and flanks, remained low; right upper quadrant (κ = .13), left upper quadrant (κ = .28), and flanks (κ range, -0.04 to .41). Most patients (97.9%; n = 94/96) rated the instructional video as clear and easy to follow.

Patient-performed abdominal self-examination using the SEAP demonstrated limited agreement with physician examinations across most abdominal regions. Agreement in the right lower quadrant was also fair. These findings indicate that patient-performed abdominal self-examination does not reliably reproduce physician assessment. However, they provide a foundation for further studies aimed at refining and better defining the role of patient-guided abdominal examinations in telemedicine settings.