Parker J S, Vukov L F, Wollan P C
Mayo Medical School, Rochester, Minnesota, USA.
Fam Med. 1996 Mar;28(3):193-7.
This study evaluated the usefulness of temperature, leukocyte count, and laboratory screening tests for abdominal pain to distinguish dischargeable from admittable illness and to distinguish admittable, nonsurgical disease from surgical disease in elderly patients (> or = 65 years) who present to the emergency department with acute (< 1 week) nontraumatic abdominal pain.
A retrospective review was done of emergency department and hospital medical records of these patients from January 1, 1993-December 31, 1993, at a large, Midwestern tertiary care center with 65,000 annual patient visits to the emergency department.
Of 231 patients who met the inclusion criteria, 51 were discharged from the emergency department, 94 were admitted without subsequent operation, and 86 were admitted directly for operation or had an operation during hospitalization. For all factors, a statistically significant difference was seen between the patients discharged and those admitted. However, the presence or absence of abnormal test values (hemoglobin, alkaline phosphatase, aspartate aminotransferase, bilirubin, lactate, and the degree of fever and leukocytosis) did not distinguish those who were admitted and did not require operation from those with surgical disease. Surgical diagnoses and prevalence of surgical illness were similar to those observed in prior geriatric studies. A significant number (13%) of surgical patients presented with normal results for all screening tests.
Temperature and laboratory screening tests for evaluation of abdominal pain in the elderly do not differentiate admittable, nonsurgical disease from surgical disease. Physicians who evaluate elderly patients with acute abdominal pain must be aware that their clinical impression of surgical illness is of greater importance than laboratory tests in the decision to request special studies or surgical consultation.
本研究评估了体温、白细胞计数及腹痛实验室筛查试验对于区分可出院疾病与需住院疾病，以及区分老年患者（≥65岁）因急性（<1周）非创伤性腹痛就诊于急诊科时需住院治疗的非手术疾病与手术疾病的有效性。
对1993年1月1日至1993年12月31日期间这些患者在一家大型中西部三级医疗中心急诊科和医院的病历进行回顾性研究，该中心每年急诊科有65000人次就诊。
在符合纳入标准的231例患者中，51例从急诊科出院，94例住院但未进行后续手术，86例直接住院手术或住院期间接受了手术。对于所有因素，出院患者与住院患者之间存在统计学显著差异。然而，检验值（血红蛋白、碱性磷酸酶、天冬氨酸氨基转移酶、胆红素、乳酸以及发热和白细胞增多程度）是否异常并不能区分需住院且无需手术的患者与患有手术疾病的患者。手术诊断及手术疾病的患病率与先前老年研究中观察到的相似。相当数量（13%）的手术患者所有筛查试验结果均正常。
用于评估老年人腹痛的体温及实验室筛查试验无法区分需住院的非手术疾病与手术疾病。评估老年急性腹痛患者的医生必须意识到，在决定是否进行特殊检查或手术会诊时，他们对手术疾病的临床判断比实验室检查更为重要。
