急诊科非特异性腹痛患者的“门诊随访”或“积极临床观察”。一项随机临床试验。

Outpatient follow-up'' or ''Active clinical observation'' in patients with nonspecific abdominal pain in the Emergency Department. A randomized clinical trial.

作者信息

Onur O E, Guneysel O, Unluer E E, Akoglu H, Cingi A, Onur E, Denizbasi A

机构信息

Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, Turkey.

出版信息

Minerva Chir. 2008 Feb;63(1):9-15.

PMID:18212722

Abstract

AIM

The aim of this study was to determine whether it is safe and cost-effective to discharge nonspecific abdominal pain (NSAP) patients from the Emergency Department (ED) and re-evaluate diagnosis later.

METHODS

Patients aged between 18 and 65 years were enrolled into the study. They had been admitted to the ED for acute abdominal pain with an indefinitive diagnosis after clinical examination and base-line investigations. The patients were randomly assigned into two groups: 1) active clinical observation (ACO), comprising those admitted to the ED observation room; 2) outpatient group (OG), comprising those discharged and asked to return for re-evaluation at 8-12 hours intervals over the following three days. Each patient was examined by an ED physician and a consultant general surgeon. Demographics, blood tests, morbidity and mortality, number of operations, together with 6-month follow-up results were noted. Finally, a patient satisfaction questionnaire was administered.

RESULTS

A total of 105 patients were enrolled into the study; 50 were randomized to the ACO group and 55 to the OG. There were no statistically significant differences in demographics and blood parameters between the two groups. Overall agreement of ED diagnosis with final diagnosis was 91.4%. Total morbidity was 10% in the ACO group and 7.2% in the OG. There were no statistically differences in morbidities and usage of diagnostic imaging modalities between the two groups (P>0.05). No deaths occurred in either group during the study period. The patients in the ACO group were more keen on returning for re-evaluation and willing to recommend our hospital services to other people (P< or =0.05).

CONCLUSION

Outpatient evaluation of patients with an ED diagnosis of NSAP may be an option, seems to be safe, is not accompanied by an increased incidence of complications and is efficient if patients are selected properly.

摘要

目的

本研究旨在确定急诊科（ED）将非特异性腹痛（NSAP）患者出院并随后重新评估诊断是否安全且具有成本效益。

方法

年龄在18至65岁之间的患者被纳入本研究。他们因急性腹痛被收治入急诊科，经临床检查和基线检查后诊断不明确。患者被随机分为两组：1）积极临床观察（ACO）组，包括收治入急诊科观察室的患者；2）门诊组（OG），包括出院并被要求在接下来三天每隔8 - 12小时返回进行重新评估的患者。每位患者均由急诊科医生和普通外科顾问医生进行检查。记录人口统计学信息、血液检查结果、发病率和死亡率、手术数量以及6个月的随访结果。最后，进行患者满意度问卷调查。

结果

共有105名患者被纳入本研究；50名被随机分配至ACO组，55名被分配至OG组。两组在人口统计学和血液参数方面无统计学显著差异。急诊科诊断与最终诊断的总体一致性为91.4%。ACO组的总发病率为10%，OG组为7.2%。两组在发病率和诊断性成像检查方式的使用方面无统计学差异（P>0.05）。研究期间两组均未发生死亡病例。ACO组的患者更愿意返回进行重新评估，并愿意向他人推荐我们医院的服务（P≤0.05）。