Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation

Nissman, Steven A.; Kaplan, Lewis J.; Mann, Barry D.

doi:10.1016/s0002-9610(02)01412-5

Cited by 31 publications

(19 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…La localización del dolor en fosa iliaca derecha establece una pequeña relación con respecto a la apendicitis aguda, presentando una exactitud de 76,5%, siendo el índice J de Jouden de 0,6 y la razón de verosimilitud (CPP o LR+) de 5,98 con un IC al 95% (2,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)68). Con respecto a la relación entre la localización del dolor en hipocondrio y la colecistitis esta presenta un incremento amplio con LR+ de 26.14 con IC al 95% (6,.…”

Section: Resultsunclassified

“…Con respecto a la relación entre la localización del dolor en hipocondrio y la colecistitis esta presenta un incremento amplio con LR+ de 26.14 con IC al 95% (6,.…”

Section: Resultsunclassified

“…The second objective was to know the percentage of patients who take painkillers during the acute process (6), and of patients who return for the same cause within 10 days after being discharged from a hospital emergency room.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Fernandez

López

Montes

et al. 2009

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

Objective: to determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain.Methods: a retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Altiplano Health Area (Murcia) was performed. In our study we considered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed diagnoses, which were retrospectively assessed by an external radiologist who was unaware of the patient's final diagnosis.Results: our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appendicitis was the main cause (approx. 25%), followed by cholecystitis (10%). We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC) and a diagnosis with cholecystitis. This location was also significant for acute appendicitis (up to 74%). Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphy's sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively.Conclusions: a) anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b) ultrasound scans offer a low diagnostic agreement index for appendicitis; and c) laparoscopy may prove useful for diagnosis, and is also a possible treatment for acute abdominal pain despite its low diagnostic efficiency.

show abstract

Section: Resultsunclassified

“…Con respecto a la relación entre la localización del dolor en hipocondrio y la colecistitis esta presenta un incremento amplio con LR+ de 26.14 con IC al 95% (6,.…”

Section: Resultsunclassified

See 1 more Smart Citation

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Fernandez

López

Montes

et al. 2009

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

show abstract

“…Historically, the reluctance among clinicians to provide analgesia to patients with acute abdominal pain 12,28,29 was thought to be due to concerns of obscuring the diagnosis of appendicitis, 30,31 leading to a delay in surgical management. 32,33 In a number of previous surveys of emergency physicians 23,28 and surgeons 19 , a large proportion of respondents chose not to provide analgesia until after surgical consultation.…”

Section: Discussionmentioning

confidence: 99%

Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments

Poonai

Cowie

Davidson

et al. 2016

CJEM

View full text Add to dashboard Cite

Objectives: Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation. Methods: Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman's Tailored Design method was used to distribute the survey from June to July 2014. Results: Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition. Conclusions: Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts. RÉSUMÉObjectifs: D'après des données, il y a une sous-utilisation, un report de l'administration et un dosage insuffisant de l'analgésie dans les services des urgences (SU) chez les patients souffrant de douleurs abdominales aiguës. En ce qui concerne les médecins qui pratiquent dans les services des urgences pédiatriques (SUP) au Canada, les auteurs ont : 1) examiné les différences de pratique théorique dans l'administration de l'analgésie chez les enfants souffrant de douleurs abdominales aiguës; 2) cerné les motifs à l'appui du report de l'administration de l'analgésie; et 3) évalué le lien entre l'administration de l'analgésie et les consultations en chirurgie.

show abstract

“…The administration of analgesics for patients with unspecified abdominal pain has been an area of disagreement between surgeons and emergency physicians in the past. 2 More recently, studies have demonstrated the safety of analgesics for abdominal pain, showing that early pain control reduces the stress response and may even improve the physical examination. [3][4][5][6][7] However, there were limitations to those studies, including a small sample size, 4,5,7 a lack of double-blinded methods, 6 and diagnoses that were conducted primarily by emergency physicians.…”

mentioning

confidence: 99%

Effect of pain control in suspected acute appendicitis on the diagnostic accuracy of surgical residents

Kang

Kim

et al. 2015

CJEM

View full text Add to dashboard Cite

show abstract

Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation

Cited by 31 publications

References 27 publications

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments

Effect of pain control in suspected acute appendicitis on the diagnostic accuracy of surgical residents

Contact Info

Product

Resources

About