| Background:About 5-10%of patients reported to the emergency department were presented with abdominal pain.Acute abdominal pain is one of the most common presenting complaints in the emergency department(ED)(Gayer 2008).Most of the patients with non-traumatic abdominal pain are discharged without specific treatment,while others are admitted into inpatient wards for further treatment.The management plan is mainly based on the physician's clinical evaluation,rather than the advanced technology and sophisticated diagnostics(Simmen,Decurtins et al.1991).It is reasonable to expect that patients with initial diagnoses of hepato-biliary-pancreatic(HBP)diseases are more likely to be admitted than those with an initial diagnosis of gastrointestinal tract(GIT)diseases,although evidence is lacking.Some physicians consider "arrival time and diagnosis" as a possible predictor for the outcomes of patients with abdominal pain,based on a speculation that patients with HBP-derived abdominal pain are more critical and progress more rapidly than those with GIT-derived abdominal pain.Consequently,HBP patients may progress more rapidly and arrive earlier than GIT patients,and are more likely to be admitted to the wards.Effects from other factors,such as age,gender,symptom duration,concurrent symptoms were not reported.This study aimed to test whether the arrival time,among other factors,determined the patients'management plan after leaving the emergency department or not.Patients and methods:From February to May 2016,we collected data about patients with a main complaint of non-traumatic abdominal pain in the Internal Medicine Clinic of the Shandong University Qilu Hospital,ED.Patients with indications for emergency surgery upon arrival,acute gastrointestinal bleeding,evidence of acute coronary heart disease-related abdominal pain,and conditions needing ICU admission were excluded.Patients' age,gender,symptom duration,arrival time,concurrent symptoms and conditions,preliminary diagnoses,and end of emergency stay(EES)were recorded.Observation endpoints were:discharge without further treatment,admission into wards,death,emergency surgery,and left against medical advice(LAMA).This study was reviewed and approved by the Qilu hospital Ethics Committee.Linear regression was performed to evaluate the factors affecting these endpoints.Statistical analyses were performed using SPSS 13.0(SPSS Inc.,Chicago,IL,USA).Both continuous and discrete variables were expressed as numbers,and percentages or frequencies.Differences in the parameters between different variables were performed by linear regression and cross tabs.P value<0.05 was regarded as statistically significant.Written informed consent was obtained from all patients.Results:Abdominal pain was the chief complaint of all patients.Most of them also complained about weight loss,loss of appetite,nausea and vomiting.A total of 167 patients were included(73 males and 94 females),with an average age of 45.5 years(range:14-96 years).Two factors affecting the management plan were preliminary diagnosis and admission month.Patients diagnosed with diseases of the gastrointestinal tract were more likely to be discharged than those diagnosed with hepatic bile and pancreatic diseases(P =0.024).Patients visiting the emergency department in May were more likely to be discharged(P = 0.003).Age,gender,symptom duration,concurrent symptoms,and arrival time were not correlated with the management plans.Conclusions:Patients with non-traumatic abdominal pain are more likely to be admitted into inpatient wards if they are diagnosed with HBP diseases than with GI diseases.The admission month also affected the patients' EES;those patients visiting the emergency department in the most crowded months are more likely to be discharged.This study failed to find a correlation between arrival time and patients' management plans.Besides the comprehensible diagnosis,the admission month was also shown to affect the management plan at the end of the emergency stay. |
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