Searching for Prognostic Factors for Nontraumatic Acute Abdominal Pain in the Emergency Department

INTRODUCTION: Nontraumatic Acute Abdominal Pain (NAAP) is one of the most common complaints in ED, but no standardised approaches are used in its management and often the clinical picture can worsen rapidly, leading to uncertainties or delays in the discharge of patients as well as in the hospitalisation. METHODS: In this work, we retrospectively considered many parameters as well as scoring systems and recognised those who were associated with the hospitalisation of patients, in order to find any one of them that was associated with the hospitalisation. As secondary endpoints we addressed interactions among variables, and we tested the performance of the scoring systems taken singularly. RESULTS: We recognised that some parameters, namely the Ranson score, the APACHE II score, the MODS score and the need for a CT scan in the diagnostic workup, when combined, were very strongly related with the need of hospitalisation, with a Sensitivity of 0.647, a Specificity of 0.979 and AUC = 0.935. For what concerns secondary endpoints, we recognised some correlations between the studied variables and showed how Ranson score was the best among the scoring system in predicting hospitalisation, with an AUC = 0.803, a Sensitivity of 0.889 and a Specificity of 0.515. DISCUSSION: Those results have been inferred from few patients (145), nonetheless the combination seems strongly related to the hospitalisation outcome and, as such, may help in the decision-making. Moreover, we recognise that it is not always feasible to calculate three scores in an ED setting. CONCLUSIONS: No single parameter or scoring system was superior to the above-mentioned combination for the prediction of the hospitalisation. Due to the low sensitivity, we suggest the use of these parameters when the hospital admission is doubtful, as a guide for the decision of discharge, in case of negativity of those parameters.