Non-specific abdominal pain in elderly patients discharged from the emergency department: frequency, outcomes and risk-factors for adverse events (EDEN-43 study)

Objective : To determine how frequent the diagnosis of non-specific abdominal pain (NSAP) is among elderly patients discharged from emergency departments (EDs), investigate short-term outcomes and look for factors related to adverse outcomes. Methods : We included all patients 65 years or older diagnosed with NSAP and discharged home after ED care in 52 Spanish EDs during a one-week period. Outcomes consisted of 7-day and 30-day all-cause death, 30-day ED reconsultation and hospitalization, and 30-day combined adverse events (AEs) (ED reconsultation, hospitalization or death). Selected sociodemographic and index episode data were investigated for their potential relationship with 30-day combined AEs. Results : Among 25,557 elderly patients attended in EDs during the 1-week period, 19,026 were discharged home and 397 (2.1%) had NSAP as the final diagnosis. The 7-day and 30-day mortality were 0.3% and 1.5%, respectively. The 30-day ED reconsultation was 21.9% and the 30-day hospitalization was 16.4%. Thirty-day combined AEs were recorded in 22.9% of patients and were independently associated with comorbidity and functional impairment as well as the use of opiate and non-opiate analgesia and lack of laboratory and imaging studies in the ED during the index episode. Conclusions : A diagnosis of NSAP at ED discharge is frequent in elderly patients and carries a risk of adverse short-term outcomes. Discharge of those patients should be cautious, especially in comorbid patients with limited functional capacity, those needing analgesia, particularly opiates, and patients discharged without laboratory and imaging studies.