Fagerström Anne, Paajanen Paavo, Saarelainen Heidi, Ahonen-Siirtola Mirella, Ukkonen Mika, Miettinen Pekka, Paajanen Hannu
a Department of Gastrointestinal Surgery , Kuopio University Hospital , Kuopio , Finland.
b School of Medicine, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland.
Scand J Gastroenterol. 2017 Oct;52(10):1072-1077. doi: 10.1080/00365521.2017.1342140. Epub 2017 Jun 28.
Distribution of diagnoses causing acute abdominal pain (AAP) may change because of population aging, increased obesity, advanced diagnostic imaging and changes in nutritional habits. Our aim was to evaluate the diagnoses causing AAP during a 26-year period.
This was a retrospective cross-sectional cohort study in one emergency department (ED) covering population about 250,000. All patients admitted to the ED in 1986, 2003 and 2012 were evaluated from hospital electronic database. Demographic data, utilization of diagnostic tests, surgical treatment and discharge diagnosis were analyzed. Statistical data of population aging, obesity and alcohol consumption during 1980-2012 were obtained from national registers.
The AAP patients represented 10-20% of our total ED census. The most common causes of AAP were nonspecific abdominal pain (NSAP, 31-37%), acute appendicitis (11-23%), biliary disease (9-11%), bowel obstruction (5-7%), acute pancreatitis (4-8%) and acute diverticulitis (1-7%). The percentage of NSAP remained highest throughout the study period. Decrease in the number of acute appendicitis (from 23 to 11%; p < .0001), increase in acute diverticulitis (from 1 to 5%; p ≤ .0001) and acute pancreatitis (from 4 to 7%; p = .0273) was observed over time. The utilization of diagnostic imaging increased significantly (CT from 2 to 37% and US from 4 to 38%, p < .0001). Hospital mortality was very low (1-2%).
NSAP is still the main differential diagnostic problem in the ED. Except acute appendicitis, distribution of specific diagnoses causing AAP remained rather stable through 26-year audit.
由于人口老龄化、肥胖率上升、先进的诊断成像技术以及饮食习惯的改变，导致急性腹痛（AAP）的诊断分布可能会发生变化。我们的目的是评估26年间导致AAP的诊断情况。
这是一项在一个急诊科进行的回顾性横断面队列研究，该急诊科覆盖人口约25万。从医院电子数据库中评估了1986年、2003年和2012年所有入住该急诊科的患者。分析了人口统计学数据、诊断检查的使用情况、手术治疗和出院诊断。1980 - 2012年间人口老龄化、肥胖和酒精消费的统计数据来自国家登记处。
AAP患者占我们急诊科总就诊人数的10 - 20%。AAP最常见的病因是非特异性腹痛（NSAP，31 - 37%）、急性阑尾炎（11 - 23%）、胆道疾病（9 - 11%）、肠梗阻（5 - 7%）、急性胰腺炎（4 - 8%）和急性憩室炎（1 - 7%）。在整个研究期间，NSAP的百分比一直最高。随着时间的推移，观察到急性阑尾炎的数量减少（从23%降至11%；p <.0001），急性憩室炎（从1%增至5%；p≤.0001）和急性胰腺炎（从4%增至7%；p =.0273）的数量增加。诊断成像的使用显著增加（CT从2%增至37%，超声从4%增至38%，p <.0001）。医院死亡率非常低（1 - 2%）。
NSAP仍然是急诊科主要的鉴别诊断问题。除急性阑尾炎外，通过26年的审查，导致AAP的特定诊断分布保持相对稳定。
