SCOPE OF PROBLEM

According to the 2004 National Hospital Ambulatory Medical Care Survey, abdominal pain accounts for more than 7.5 million annual patient visits to emergency departments (ED) throughout the United States. Abdominal pain is the most frequently reported principal reason given by patients for visiting the ED, accounting for almost 7% of all ED visits. It is also the leading discharge diagnosis in patients aged 22–49 years.

Abdominal pain constitutes a very diverse group of diagnoses ranging from benign and self-limited conditions, such as gastroenteritis, to acute and life-threatening diseases, such as ischemic bowel or ruptured aortic aneurysms. The challenge for emergency physicians is to correctly differentiate those patients whose abdominal condition may be imminently life threatening or require surgery, from those who require a more extended evaluation and treatment or may be discharged. The ultimate challenge is to safely accomplish this and at the same time providing the patient maximum comfort.

CLINICAL ASSESSMENT

Until recently, patients presenting to the ED with abdominal pain underwent a clinical evaluation consisting of a routine history and physical examination, a panel of laboratory tests, and perhaps plain radiographs. During their ED stay these patients were kept NPO in case they might require emergent surgery, and were rarely given analgesic medications prior to evaluation by a surgeon. Those without worrisome findings were discharged home (usually without analgesics), and those with concerning findings were kept in the ED or hospitalized for continued observation and reexamination.