Acute Abdominal Pain among Elderly Patients

Abstract

Background: Diagnosis of acute abdominal pain in older persons is a challenge, with the age-related increase in concurrent diseases. In most western countries the number of elderly people is constantly rising, which means that an increasing proportion of patients admitted for abdominal pain at the emergency department are elderly. Objective: To characterize differences in clinical presentation and diagnostic accuracy between younger and more elderly patients with acute abdominal pain. Methods: Patients admitted to Mora Hospital with abdominal pain of up to seven days’ duration were registered according to a detailed schedule. From 1st February 1997 to 1st June 2000, 557 patients aged 65–79 years and 274 patients aged ≧80 years were registered. Patients aged 20–64 years (n = 1,458) served as a control group. Results: A specific diagnosis, i.e. other than ‘nonspecific abdominal pain’, was established in 76 and 78% of the patients aged 65–79 and ≧80 years respectively, and in 64% of those aged 20–64 (p < 0.001). Pain duration before admission increased with age (p < 0.003), as did frequency and duration of hospitalization (p < 0.0001). Hospital stay increased from 170 days per 100 emergency admissions in the control group to 320 and 458 days in the younger and older study groups, respectively. At the emergency department, older patients were more often misdiagnosed than control patients (52 vs. 45%; p = 0.002). At discharge the diagnosis was more accurate in the control group (86 vs. 77%; p < 0.0001). Hospital mortality was higher among older patients (23/831 vs. 2/1,458; p < 0.001). The admission-to-surgery interval was increased (1.8 vs. 0.9 days, p < 0.0001) in patients ≧65 years. Rebound tenderness (p < 0.0001), local rigidity (p = 0.003) and rectal tenderness (p = 0.004) were less common in the older than in the control patients with peritonitis. In patients ≧65 years, C-reactive protein did not differ between patients operated on and those not, contrary to the finding in patients <65 years (p < 0.0001). Conclusion: Both the preliminary diagnosis at the emergency department and the discharge diagnosis were less reliable in elderly than in younger patients. Elderly patients more often had specific organic disease and arrived at the emergency department after a longer history of abdominal pain compared to younger patients.

Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management

“…Managing patients of advanced age is known to be more challenging for emergency physicians (EPs) to make accurate diagnoses [1,3], given the unreliability of clinical and biological predictors of disease [4,5], overlapping presentations and coexisting disease in this population. Elderly patients admitted to the ED for acute abdominal pain have higher mortality, admission levels and number of surgical procedures [1,5] than younger Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4425-0) contains supplementary material, which is available to authorized users. patients.…”

“…patients. Moreover, surgery delays have been underlined as a crucial morbidity and mortality factor in this population [5][6][7]. Ten years ago, Lewis et al [1] had already recommended further study in elderly patients to help define both a higher risk population requiring admission and treatment and a lower risk population who could be safely discharged.…”

“…According to the American College of Radiology (ACR) guidelines, CT of the abdomen and pelvis after intravenous contrast administration is the radiologic procedure with the highest diagnostic performance rating [9,10], leading to both improvement in diagnosis and management on unselected adult populations [11][12][13][14], as on elderly ones [1,[15][16][17]. Some authors have advocated a more generous CT scan strategy regarding elderly patients with acute abdominal pain, even in the absence of pronounced signs of an inflammatory intra-abdominal process, in order to shorten the delay from ED admission to surgery [5]. However, liberal use of CT scan could have two major shortcomings.…”

Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman

“…Additionally, they tend to wait longer to seek medical attention, are more likely to present with vague symptoms and nonspecific findings on presentation and there is a higher incidence of asymptomatic underlying pathology. Diminished sensorium is common and permits pathology to advance to a risky point prior to symptom development [9]. Due to the described factors, many elderly patients are misdiagnosed with relatively benign conditions and are at greater risk of being admitted to the wrong service (i.e., internal medicine when a surgeon may be required as realized in our case).…”

Geriatrik hastada akut karın ağrısına yaklaşım

“…Safra kesesi hastalıkları yaşlı hastalarda en sık karın ağrısı nedeni olduğu gibi aynı zamanda batın içi operasyon gerektiren en sık nedendir (37). Safra taşlarının görülme prevalansı yaşla giderek artar ve 70 yaşında % 33'lere ulaşır (38).…”