SIMPLE DATA FROM HISTORY AND PHYSICAL-EXAMINATION HELP TO EXCLUDE BOWEL OBSTRUCTION AND TO AVOID RADIOGRAPHIC STUDIES IN PATIENTS WITH ACUTE ABDOMINAL-PAIN

Objective: To assess the value of plain abdominal radiographs and of d ata from the medical history and physical examination in the diagnosis of acute abdominal pain in general and of bowel obstruction in partic ular. Design: Prospective study. Setting: 4 university and 2 community hospitals, Germany. Subjects: 1254 patients with acute abdominal pain lasting less than 7 days, and with no history of abdominal injury inc luding surgery. Interventions: Standardised and structured medical his tory and physical examination, study of results of plain abdominal rad iographs. Main outcome measures: Positive predictive value and sensiti vity of clinical variables and abdominal film with respect to the diag nosis at discharge. Results: 48 patients (3.8%) had bowel obstruction. 704 patients (56.1%) had plain abdominal films taken at the time of i nitial presentation. 111 studies (15.8%) showed important findings lea ding to diagnosis or immediate treatment, 455 (64.7%) showed unimporta nt or no findings. In 138 (19.6%) results of films were not reported. 16 of 45 single variables were of help in diagnosing bowel obstruction . The six with the highest sensitivity were distended abdomen, increas ed bowel sounds, history of constipation, previous abdominal surgery, age over 50, and vomiting. If only patients presenting with any two of these symptoms had had radiographs taken, 300 (42.6%) could have been avoided without loss in diagnostic accuracy. Conclusion: A considerab le number of plain abdominal films taken for patients with acute abdom inal pain could be avoided by focusing on clinical variables relevant to the diagnosis of bowel obstruction.