Hospital admissions of patients aged over 80 with acute abdominal complaints

Objective: Evaluation of the outcome of patients aged over 80 with acute ab dominal complaints, who were admitted to the hospital through the emergency department. Design: Retrospective study. Setting: City hospital, the Netherlands. Patients: 132 patients aged over 80 with acute abdominal complaints who wer e admitted through the emergency department in 1997. Main outcome measures: Diagnosis at admission and discharge or necropsy, di agnostic tests, treatment, morbidity, and mortality. Results: In 27 of 132 patients (20%) the diagnosis on discharge or at necro psy differed from the initial diagnosis in the emergency department; in 18 patients (14%) an important diagnosis was missed and the severity was under estimated. Within the first 24 hours, 97% (n = 128) had blood tests, 63% (n = 83) urine tests, 58% (n = 76) plain radiograph of the abdomen, 20% (n = 26) ultrasonography, and 3% (n = 4) computed tomography (CT) of the abdomen . Of all the patients admitted, 35 (27%) were operated on. The hospital mor tality of the admitted patients was 17% (n = 23) and of these operated on 3 4% (n = 12). The mortality in the 27 misdiagnosed patients was 59% (n = 16) . The morbidity among the 109 surviving patients was 22%. Conclusions: Mortality was high among those aged over 80 with acute abdomin al complaints who were admitted through the emergency department, particula rly among those who were operated on and those who were misdiagnosed. Guide lines for an earlier and more comprehensive diagnostic approach could lead to better insight into the prognosis and thereby to more adequate and bette r-targeted treatment.