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HOUSTON – Stomach and abdominal pain, cramps and spasms are the leading reasons for emergency department visits, making up more than 8% of all presentations, according to the National Hospital Ambulatory Medical Care Survey.
The problem, according to research published recently in the Emergency Medical Journal, is that acute abdominal pain also can have a high rate of misdiagnosis.
Researchers from the Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, both in Houston, report that diagnostic process breakdowns in ED patients with abdominal pain most commonly involved history taking, ordering insufficient tests in the patient–provider encounter and problems with follow-up of abnormal test results.
“In looking at the prior emergency medicine literature, abdominal pain was one of the chief complaints that was most frequently associated with diagnostic errors, but it had the least amount of research done on it,” said Laura Medford-Davis, MD, assistant professor of emergency medicine at Baylor.
Hardeep Singh, MD, of Baylor and the VA added, “Not only is it fairly common as a presenting symptom, but it’s also one that could be missed or misdiagnosed.”
For the study, researchers used electronic health records to develop an electronic trigger to help identify patients who presented with acute abdominal pain, returned within 10 days after their first ER visit and were admitted to the hospital when they returned.
Reviewing the electronic records of the 100 patients returning to the ED, the study group found 35 diagnostic errors during the initial visits. More than two-thirds of the errors were related to the patient/provider encounter, including history taking, the initial examination or failure to order additional tests at the time the patient presented. Follow-up of abnormal test results also was a problem.
The study identifies two errors that could have caused immediate death, one that had the potential for very serious damage and two more that had the potential for very serious harm.
“Emergency rooms are busy and often chaotic. Moreover, the diagnosis is often not clear when patients first present nor is diagnosis always black and white,” Singh explained. “Our methodology of using rigorous reviews overcomes some of the limitations to measure misdiagnosis. Once these measurements are in place, emergency departments can implement improvement strategies for these types of diagnostic errors.”
Researchers call for better follow-up and reporting strategies for the ED and intervention programs to detect and reduce risk of misdiagnosis, while also recommending more patient education on what they should do when their condition changes.