Abdominal pain in geriatric emergency patients: Variables associated with adverse outcomes

Objective: To determine the diagnoses and outcomes of geriatric patients wi th abdominal pain, and to identify variables associated with adverse outcom es. Methods: Geriatric emergency patients (aged 65 years and older) with a complaint of abdominal pain were participants in this longitudinal case ser ies. Eligible patients were followed by telephone contact and chart review, to determine outcomes and final diagnoses. Results: Of 380 eligible patien ts, follow-up information was available for 375 (97%), for the two months f ollowing the ED visit. Final diagnoses included infection (19.2%), mechanic al-obstructive disorders (15.7%), ulcers/hypersecretory states (7.7%), urin ary tract disease (7.7%), malignancy (7.2%), and others. Although 5.3% of t he patients died (related to presenting condition), most (61.3%) patients u ltimately recovered. Surgical intervention was required for 22.1% of the pa tients. Variables associated with adverse outcomes (death, and need for sur gical intervention) included hypotension, abnormalities on abdominal radiog raphy, leukocytosis, abnormal bowel sounds, and advanced age. Most physical examination findings were not helpful in identifying patients with adverse outcomes. This study demonstrated a higher incidence of malignancy (7.2%) and a lower incidence of disease necessitating surgical intervention (22.1% ) than previously reported. Conclusions: The majority of geriatric emergenc y patients with abdominal pain have significant disease necessitating hospi tal admission. Morbidity and mortality among these patients are high, and s pecific variables are strongly associated with death and the need for surgi cal intervention. Absence of these variables does not preclude significant disease. Physical examination findings cannot reliably predict or exclude s ignificant disease. These patients should be strongly considered for hospit al admission, particularly when fever, hypotension, leukocytosis, or abnorm al bowel sounds are present.