Unplanned Revisits to the Emergency Department for Surgical Abdominal Emergencies at a Tertiary Teaching Referral Hospital in Jordan

Introduction: Surgical abdominal emergencies are a common cause of emergency department (ED) visits and represent the leading reason for non-trauma-related hospital admissions. Timely and accurate diagnosis during the initial ED visit is crucial for effective management and helps reduce healthcare costs, complications, morbidity, and mortality rates. Aim: This study aimed to determine the proportion of surgical abdominal emergencies diagnosed after multiple (two or more) ED visits, identify factors contributing to diagnostic delays, and compare outcomes between patients diagnosed at the first visit and those diagnosed after multiple visits. Methods: This retrospective cohort study included patients diagnosed with surgical abdominal emergencies at the ED of Jordan University Hospital, a tertiary referral teaching hospital, between January 2019 and October 2020. Data were extracted from electronic medical records (EMRs) and ED documentation and analyzed using SPSS version 25. Results: Of the 178 patients included, 17 (9.6%) were diagnosed only after two or more ED visits. In 12 of these 17 cases (70.6%), an alternative diagnosis was given during the initial visit (p = 0.001). Physical disability was the only factor significantly associated with delayed diagnosis (p = 0.006). Patients diagnosed at their first ED visit presented with more symptoms, underwent broader laboratory testing, had a higher incidence of abnormal lab results, and received more imaging studies. There was no significant difference between the two groups in terms of post-operative complications or hospital length of stay. Discussion: The proportion of delayed diagnoses in our study aligns with ranges reported in similar studies. Unlike some previous research, this study did not find significant associations between misdiagnosis and variables such as physician experience or time of presentation. Our findings were consistent with a U.S.-based study that also reported more frequent abnormal laboratory results in correctly diagnosed patients. Additionally, in agreement with certain studies, no significant difference in complication rates or hospital stay length was observed between the groups. Conclusion: Physical disability was the only factor significantly associated with misdiagnosis in cases of surgical abdominal emergencies. Other variables such as insurance status, physician experience, and time of presentation did not show a statistically significant impact.