Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Am Geriatr Soc. 2022 Feb;70(2):501-511. doi: 10.1111/jgs.17503. Epub 2021 Oct 10.
Abdominal pain is the most common chief complaint in US emergency departments (EDs) among patients over 65, who are at high risk of mortality or incident disability after the ED encounter. We sought to characterize the evaluation, management, and disposition of older adults who present to the ED with abdominal pain.
We performed a survey-weighted analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS), comparing older adults with a chief complaint of abdominal pain to those without. Visits from 2013 to 2017 to nationally representative EDs were included. We analyzed 81,509 visits to 1211 US EDs, which projects to 531,780,629 ED visits after survey weighting. We report the diagnostic testing, evaluation, management, additional reasons for visit, and disposition of ED visits.
Among older adults (≥65 years), 7% of ED visits were for abdominal pain. Older patients with abdominal pain had a lower probability of being triaged to the "Emergent" (ESI2) acuity on arrival (7.1% vs. 14.8%) yet were more likely to be admitted directly to the operating room than older adults without abdominal pain (3.6% vs. 0.8%), with no statistically significant differences in discharge home, death, or admission to critical care. Ultrasound or CT imaging was performed in 60% of older adults with abdominal pain. A minority (39%) of older patients with abdominal pain received an electrocardiogram (EKG).
Abdominal pain in older adults presenting to EDs is a serious condition yet is triaged to "emergent" acuity at half the rate of other conditions. Opportunities for improving diagnosis and management may exist. Further research is needed to examine whether improved recognition of abdominal pain as a syndromic presentation would improve patient outcomes.
在超过 65 岁的美国急诊部（ED）患者中，腹痛是最常见的主诉，这些患者在 ED 就诊后死亡或新发残疾的风险很高。我们试图描述因腹痛就诊 ED 的老年患者的评估、管理和处置情况。
我们对全国医院门诊医疗调查（NHAMCS）进行了调查加权分析，将以腹痛为主要症状的老年患者与无腹痛的患者进行了比较。纳入了 2013 年至 2017 年期间全国代表性 ED 的就诊记录。我们分析了来自 1211 家美国 ED 的 81509 次就诊记录，经过调查加权后可推断出 531780629 次 ED 就诊。我们报告了 ED 就诊的诊断性检查、评估、管理、就诊的其他原因和处置情况。
在老年患者（≥65 岁）中，7%的 ED 就诊是因为腹痛。腹痛的老年患者在到达时被分诊为“紧急”（ESI2）级别的可能性较低（7.1% vs. 14.8%），但比没有腹痛的老年患者更有可能直接被送往手术室（3.6% vs. 0.8%），但出院回家、死亡或入住重症监护病房的比例没有统计学差异。有 60%的腹痛老年患者接受了超声或 CT 成像检查。只有少数（39%）的腹痛老年患者接受了心电图（EKG）检查。
在 ED 就诊的老年患者中，腹痛是一种严重的疾病，但分诊为“紧急”级别的比例仅为其他疾病的一半。可能存在改善诊断和管理的机会。需要进一步研究以检验是否改善对腹痛作为综合征表现的认识会改善患者的结局。
