Factors associated with an unfavorable outcome in patients visiting the emergency department with acute abdominal pain

Abstract

Abstract Background Unfavorable outcome occurs in patients who visit the emergency department (ED) with acute abdominal pain. We aimed to determine the factors associated with unfavorable outcome in ED patients who presented with acute abdominal pain. Methods A retrospective cohort study was conducted from July 1, 2015 to June 30, 2016. The inclusion criteria were patients aged older than 18 years who presented to the emergency department (ED) with acute abdominal pain. The patients were divided into either the favorable outcome group or unfavorable outcome group. The two groups were compared in terms of baseline characteristics, triage category, physical examination findings, duration of symptoms, laboratory and imaging results, final diagnosis, treatment in the ED, emergency department length of stay (EDLOS), and ED disposition, morbidity, and mortality. The significant associated factors for an unfavorable outcome were examined using univariate and multivariate analyses by logistic regression. Results A total of 951 patients were included in the study. The multivariate logistic regression analysis showed EDLOS > 4 hours (adjusted odd ratio (AOR) 2.62, 95% CI: 1.33–5.14, p = 0.005), diastolic blood pressure (DBP) < 80 mmHg (AOR 3.31, 95% CI: 1.71–6.4, p ≤ 0.001), respiratory rate ≥ 24 breaths/min (AOR 2.03, 95% CI: 1.07–3.86, p ≤ 0.031), right lower quadrant (RLQ) tenderness (AOR 3.72, 95% CI: 1.89–7.32, p ≤ 0.001), abdominal distension (AOR 2.91, 95% CI: 1.29–6.57, p = 0.010), hypoactive bowel sounds (AOR 2.89, 95% CI: 1.09–7.67, p = 0.033), presence of specific abdominal signs (AOR 2.07, 95% CI: 1.1–3.88, p = 0.024), leukocytosis ≥ 12,000 cells/mm3 (AOR 2.37, 95% CI: 1.22–4.6, p = 0.011), and absolute neutrophil count (ANC) > 75% (AOR 2.83, 95% CI: 1.39–5.75, p = 0.004) were revealed as significant factors associated with unfavorable outcome. Significant variables associated with in-hospital mortality in the unfavorable outcome group were presence of shock (p ≤ 0.001), mechanical ventilation used (p = 0.008), emergency surgery required (p = 0.007), and occurrence of in-hospital cardiac arrest (p = 0.002). Emergency surgical procedures performed were appendectomy (58.5%, 38 patients), exploratory laparotomy (29.2%, 19 patients), laparoscopy (7.7%, 5 patients), and cholecystectomy (4.6%, 3 patients). Three patients died after admission and one patient died at the ED. Conclusions The present study revealed that the significant clinical signs associated with the occurrence of unfavorable outcome were DBP < 80 mmHg, tachypnea (≥ 24 breaths/minute), RLQ tenderness, abdominal distension, hypoactive bowel sounds, and presence of specific abdominal signs. Moreover, associated laboratory results identified from this study were leukocytosis and ANC > 75%. Finally, ED patients with abdominal pain who had EDLOS longer than 4 hours were associated with unfavorable outcome.