Acute abdominal pain in the emergency department: Physicians' use of opioid analgesics and the incidence of serious outcomes

Physicians have traditionally withheld opioid analgesics from patients with acute abdominal pain due to concerns of masking physical findings. No study has examined morbidity and mortality after narcotic administration. The purpose of this study was to determine: (1) frequency of abdominal pain requiring narcotic analgesics, and (2) rate of serious outcomes, (death, infection, perforation, obstruction or hemorrhage of abdominal organs), in order to assess the feasibility of a randomized clinical trial on the safety of narcotics. Of 860 patients with acute abdominal pain, 477 (55%) completed a pain questionnaire, and 321 met study criteria for need of narcotic analgesia (37.3%). Of these, 36 (11.2%) experienced a serious outcome as assessed by telephone contact 2 to 3 weeks after initial visit. The overall rate of serious outcomes was 67 of 860 (7.8%). A clinical trial using serious outcomes as the primary endpoint is possible, but would need to randomize approximately 3200 patients.