EMERGENCY DEPARTMENT DIAGNOSIS OF ABDOMINAL DISORDERS IN THE ELDERLY

To assess the accuracy of emergency department (ED) provisional diagno sis (ProDx) as compared with the hospital discharge diagnosis (HDDx) a nd the impact on hospital morbidity and mortality among nonelderly and elderly persons presenting with acute nontraumatic abdominal complain ts, a retrospective review was conducted of 1,863 nonelderly (younger than 65 years) and 428 elderly (65 years or older) adults admitted to a university hospital from its ED. The sensitivity/specificity of the ProDx was 82%/86% for patients younger than 65 versus 68%/76% for thos e 65 or older. When the ProDx and HDDx did not agree, the overall dise ase related morbidity was 16% for patients younger than 65 versus 45% for those 65 or older (P < .02). There were no differences in mortalit y based on agreement of the ProDx and HDDx. Prospective studies to det ermine the factors that are most useful in the ED diagnosis of acute n ontraumatic abdominal disorders in the elderly are needed to improve t he accuracy of diagnosis and reduce the incidence of morbidity in this high risk group. (Am J Emerg Med 1998;16:357-362. Copyright (C) 1998 by W.B, Saunders Company).