DECISION-MAKING IN ACUTE ABDOMINAL-PAIN - ACCURACY, COSTS AND AVAILABILITY OF VARIOUS DIAGNOSTIC METHODS

Acute abdominal pain may be caused by numerous diseases, both surgical and nonsurgical. Severe, fatal diseases may present as vague abdominal discomfort, while harmless, functional symptoms may appear alarming in another patient. Prompt diagnosis and treatment are needed on a continuous 24-h basis, even during weekends and holiday periods. Furthermore, the number of patients with these complaints is large. Thus, several excellent, sensitive and also highly specific diagnostic methods cannot be used in all patients, because of their high costs and limited availability during nights and weekends. The best, most simple and cheapest screening method for these patients is a clinical examination together with the measurement of plasma C-reactive protein and routine urine analysis. The routine use of a structured record, together with audit feedback and computer aid may give the same precision. This screening enables the doctor to group these patients according to the need for, and urgency of, further diagnostic methods and treatment. Patients thus found or suspected to have severe, acute abdominal disease need urgent diagnostic evaluation by a surgeon, since many of the acute abdominal diseases require sophisticated radiological examinations and/or urgent surgical treatment. The need for later follow-up examination in patients not suspected to have acute abdominal disease may also be judged by the results of this simple screening with clinical examination, plasma C-reactive protein and urine analysis.