Diagnosis of acute abdominal pain in the accident and emergency department

Abstract

This paper reports the findings in a study involving 1537 patients with 'acute abdominal pain' presenting over a 13-month period to the Accident and Emergency Department of the General Infirmary at Leeds. Of these, 341 patients who proved to have pain of greater duration than a week, pain incidental to some other identifiable condition or no pain at the time of their attendance were excluded. The remaining 1196 were diagnosed clinically (using a structured case sheet) and subsequently by a Bayesian computer system. Feedback of the results of clinical and computer systems was given to clinicians at regular intervals. Clinical diagnostic accuracy in patients with surgical disorders rose from 40 per cent before the study to 61 per cent. Computer accuracy in these patients was 69-9 per cent. The proportion of patients sent home without ill effects rose from 20 per cent to 39 per cent. In other areas (e.g. gynaecology) the effects were less marked. It is suggested that the introduction of a simple postgraduate educational service, aided by a small computer, might prove of practical benefit in this clinical situation.

Computer-aided diagnosis of lower abdominal pain in women

“…This is not the first study in computer-aided diagnosis of gynaecological disorders ; however, previous attempts (e.g. Neurath et al, 1969) have been less successful-and indeed our own initial results (Wilson et al, 1977) were much less satisfactory than those reported here. It is worth investigating some possible reasons for this.…”

Systematic reviews of clinical decision tools for acute abdominal pain

“…Thirteen studies were excluded because they were neither randomised nor quasi-randomised controlled trials. The breakdown of the designs used was as follows: four uncontrolled before-and-after studies, [164][165][166][167] one externally controlled before-and-after study, 116 three interrupted timeseries studies with fewer than six data points, [168][169][170] two interrupted time-series studies with six or more data points 171,172 and three prospective cohort studies. 51,173,174 One study was excluded because it did not ask an appropriate study question (upon scrutiny it was found to be an accuracy study only, not an impact study).…”

“…51,171,172,[216][217][218][219][220] Of these eight papers, five attempted to examine the costs and benefits of AAP decision tools. One other paper was identified through other means.…”

“…An appraisal will be conducted on a cost-benefit analysis, 219 which elaborated or updated on the economic data presented in other Leeds studies. 51,171,172,217 De Dombal 219 reported that the study by Adams and colleagues 51 demonstrated conclusively that the Leeds AAP system reduced length of hospital stay, the number of AAP patients admitted to hospital, perforated appendix rates and negative laparotomy rates. Based on these figures, De Dombal estimated that at a nationwide level, annual savings to the NHS would amount to £28 million, and reported the cost of each computer system at £3000 and each part-time computer assistant at £3000 per year (1986 prices).…”

Computer-Aided Diagnosis and Decision-Making in Acute Abdominal Pain

“…Ex cept for two studies [15,21], computer anal ysis was carried out in Leeds using British and/or international data base. In the British studies [12,16] the computer was superior to the clinicans in terms of diagnostic accuracy. In the Danish study [15] the clinicians played equal with the computer while in the rest of reports the computer-assisted system did not perform as well as the clinicians.…”