Marco C A, Schoenfeld C N, Keyl P M, Menkes E D, Doehring M C
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Acad Emerg Med. 1998 Dec;5(12):1163-8. doi: 10.1111/j.1553-2712.1998.tb02689.x.
To determine the diagnoses and outcomes of geriatric patients with abdominal pain, and to identify variables associated with adverse outcomes.
Geriatric emergency patients (aged 65 years and older) with a complaint of abdominal pain were participants in this longitudinal case series. Eligible patients were followed by telephone contact and chart review, to determine outcomes and final diagnoses.
Of 380 eligible patients, follow-up information was available for 375 (97%), for the two months following the ED visit. Final diagnoses included infection (19.2%), mechanical-obstructive disorders (15.7%), ulcers/hypersecretory states (7.7%), urinary tract disease (7.7%), malignancy (7.2%), and others. Although 5.3% of the patients died (related to presenting condition), most (61.3%) patients ultimately recovered. Surgical intervention was required for 22.1% of the patients. Variables associated with adverse outcomes (death, and need for surgical intervention) included hypotension, abnormalities on abdominal radiography, leukocytosis, abnormal bowel sounds, and advanced age. Most physical examination findings were not helpful in identifying patients with adverse outcomes. This study demonstrated a higher incidence of malignancy (7.2%) and a lower incidence of disease necessitating surgical intervention (22.1%) than previously reported.
The majority of geriatric emergency patients with abdominal pain have significant disease necessitating hospital admission. Morbidity and mortality among these patients are high, and specific variables are strongly associated with death and the need for surgical intervention. Absence of these variables does not preclude significant disease. Physical examination findings cannot reliably predict or exclude significant disease. These patients should be strongly considered for hospital admission, particularly when fever, hypotension, leukocytosis, or abnormal bowel sounds are present.
确定老年腹痛患者的诊断及预后情况，并识别与不良预后相关的变量。
本纵向病例系列研究的参与者为因腹痛前来就诊的老年急诊患者（年龄65岁及以上）。通过电话联系和病历审查对符合条件的患者进行随访，以确定预后和最终诊断。
在380例符合条件的患者中，有375例（97%）在急诊就诊后的两个月内获得了随访信息。最终诊断包括感染（19.2%）、机械性梗阻性疾病（15.7%）、溃疡/高分泌状态（7.7%）、泌尿系统疾病（7.7%）、恶性肿瘤（7.2%）及其他疾病。尽管5.3%的患者死亡（与就诊时的病情相关），但大多数患者（61.3%）最终康复。22.1%的患者需要手术干预。与不良预后（死亡及需要手术干预）相关的变量包括低血压、腹部X线检查异常、白细胞增多、肠鸣音异常及高龄。大多数体格检查结果对识别有不良预后的患者并无帮助。本研究显示，恶性肿瘤的发生率（7.2%）高于以往报道，而需要手术干预的疾病发生率（22.1%）低于以往报道。
大多数老年腹痛急诊患者患有需要住院治疗的严重疾病。这些患者的发病率和死亡率较高，特定变量与死亡及手术干预需求密切相关。没有这些变量并不排除存在严重疾病。体格检查结果不能可靠地预测或排除严重疾病。对于这些患者，尤其是出现发热、低血压、白细胞增多或肠鸣音异常时，应强烈考虑收入院治疗。
