Acute abdominal pain: Advances in diagnosis and management

The term acute abdominal pain refers to non-traumatic abdominal pain of rapid onset with duration of less than five days. Acute abdominal pain can be divided in urgent and non-urgent conditions. Urgent causes require treatment within 24 hours to prevent serious complications whereas for non-urgent conditions treatment is not necessitated within a fixed period of time. The majority of patients are discharged home immediately after ED evaluation.
The accuracy of the clinical diagnosis in patients presenting with acute abdominal pain at the Emergency Department is low even though additional imaging increases the diagnostic accuracy. Imaging in all patients would lead to over-utilization, exposing the majority of patients to unnecessary risks, prolong throughput at the ED and place a major burden on the health care system. The first part of this thesis explores means to increase the accuracy of the clinical diagnosis. If, based on clinical evaluation, patients with an urgent condition could be distinguished from patients with a non-urgent condition over-utilization of imaging could be restricted. The second part of this thesis evaluates current imaging strategies in selected patient groups. The effectiveness of the conditional imaging strategy has been proven in a general population of patients with acute abdominal pain but it has not been investigated yet whether this is also the preferred strategy in patients with rare but severe diseases such as AMI or diseases with a very typical clinical presentation. In patients who undergo an abdominal CT it still is under debate what type of enhancement is preferred. The third part assessed the implementation of evidence into daily practice.