A Novel Approach to Patients with Equivocal Non-Traumatic Acute Abdominal Pain

Abstract

Introduction Patients with acute abdominal pain are sometimes held under long-term observation because of failure to make a certain diagnosis. This study investigates the effectiveness of utilising laboratory and clinical variables to choose between surgical and medical treatment to reduce costs and speed up the evaluation period. Methods In a university hospital setting, 165 patients with abdominal pain who had undergone surgical (n=115) or nonsurgical (n=50) treatment after observation were prospectively analysed. Upon presentation body temperature, white blood cell count, neutrophil count, seroreactive protein, and malonyl dialdehyde levels were determined. The area under the ROC curve and logistic regression analyses were performed. Surgical probability formula was prepared by using parameters. Results Body temperature, white cell count, neutrophil count, C-reactive protein were higher in the surgical group (p=0.0001). Sensitivity of C-reactive protein was higher in determining patients who required surgical treatment. Multivariate analysis showed that above mentioned variables (except neutrophil count) along with malonyl dialdehyde levels were effective in determining optimal treatment strategy. Conclusions It is possible to identify patients who need to undergo surgery by implementation of a ‘probability of surgery’ model using certain laboratory values from blood samples obtained from patients with abdominal pain and unknown diagnosis, upon presentation in the emergency room.