Acute abdominal pain in general practice: tentative diagnoses and handling

Abstract

Objective. To investigate the spectrum of diagnoses made by general practitioners (GPs) seeing patients with acute abdominal pain, as well as GPs’ handling of these patients. To investigate factors predictive of acute admission to hospital. Design. Descriptive study. Setting. General practices in southern Norway, autumn 2007 and spring 2008. Subjects. A total of 134 patients who were offered an acute appointment with a GP because of abdominal pain. Main outcome measures. Tentative diagnosis made and handling of the patient by the GP. Explanatory factors: pain duration, findings on clinical examination. Results. The most frequent diagnosis was non-specific pain (20%), followed by gastroenteritis (13%), appendicitis (12%), ulcer disease (11%), gynaecological disease (9%), and urinary tract problems (7%). One-quarter of patients were sent home after clinical examination without any specific action taken. One-quarter were acutely admitted to hospital, and one-quarter were treated with medication. The rest was either referred for further investigations on a non-acute basis (14%) or given a follow-up appointment with the GP (10%). Suspected appendicitis was the strongest predictor for acute admission. Rebound tenderness on clinical examination as well as pain duration for 24 hours or less also independently predicted acute hospital admission. Conclusion. GPs face the challenge of meeting a wide and inhomogeneous spectre of complaints when dealing with patients with acute abdominal pain. Three-quarters of patients are taken care of in primary care.

• Acute abdominal pain
• family practice
• general practice