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Clinical Features, CT Imaging Decisions and Yield by Age in Adults With Abdominal Pain in the Emergency Department.

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Τίτλος: Clinical Features, CT Imaging Decisions and Yield by Age in Adults With Abdominal Pain in the Emergency Department.
Συγγραφείς: Friedman AB; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Adjei-Poku MN; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Schadt LA; School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Li Y; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Cappola AR; Division of Endocrinology, Diabetes, and Metabolism, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Kelz RR; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Hwang U; Department of Emergency Medicine, NYU Grossman School of Medicine, New York City, New York, USA.; James J Peters VA Medical Center, New York, USA.; NYU Langone Health, New York, USA., Kowdley G; Tidal Health General Surgery, Tidal Health, Salisbury, Maryland, USA., Mwinyogle A; Vascular Surgery, Faith Regional Health Services, Norfolk, Nebraska, USA., Trueger NS; Department of Emergency Medicine Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.; JAMA Network Open, Chicago, Illinois, USA.
Πηγή: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2026 May; Vol. 33 (5), pp. e70299.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wiley Country of Publication: United States NLM ID: 9418450 Publication Model: Print Cited Medium: Internet ISSN: 1553-2712 (Electronic) Linking ISSN: 10696563 NLM ISO Abbreviation: Acad Emerg Med Subsets: MEDLINE
Imprint Name(s): Publication: Hoboken, N.J. : Wiley
Original Publication: Philadelphia, PA : Hanley & Belfus, c1993-
Ιατρικοί όροι (MeSH): Abdominal Pain*/diagnostic imaging , Abdominal Pain*/etiology , Abdominal Pain*/diagnosis , Tomography, X-Ray Computed*/statistics & numerical data , Emergency Service, Hospital*, Humans ; Female ; Middle Aged ; Retrospective Studies ; Male ; Adult ; Age Factors ; Aged ; Emergency Room Visits ; Adolescent ; Young Adult ; Baltimore ; Sensitivity and Specificity
Περίληψη: Objectives: Older adults with abdominal pain present diagnostic uncertainty due to less informative histories/exams, broader etiologies, and higher morbidity. Whether ED imaging decisions are calibrated to this risk is unclear. The objective of this study was to compare age-stratified clinical features, CT utilization, and CT diagnostic yield, and to assess how history/physical and clinician pretest suspicion relate to adverse outcomes.
Methods: This was a retrospective cohort analysis of data from a prospective cohort collected from March 2016-January 2017 at a single community teaching hospital emergency department in southwest Baltimore. We analyzed 1169 visits of adults presenting with nontraumatic abdominal pain including 229 (19.6%) aged ≥ 60 years. Patients < 18 years were excluded. Age groups were 18-39, 40-59, ≥ 60 years. Outcomes were CT ordering, acute actionable CT findings, admission, surgery, and a composite of adverse outcomes (any actionable CT finding, admission, surgery, or Emergency General Surgical diagnosis). History and physical examination operating characteristics (e.g., sensitivity/specificity of tenderness, rebound) were also calculated.
Results: Of 1169 visits, 19.6% were aged ≥ 60 years. CT ordering increased with age (41.7%, 66.2%, 70.7% for 18-39, 40-59, ≥ 60; p < 0.001), as did CT yield (18.4%, 31.2%, 37.7%; p < 0.001). Admissions (12.1%, 28.0%, 37.6%) and surgeries (4.6%, 9.0%, 10.6%) also rose with age. Clinician pretest suspicion was similar across age groups. Abdominal tenderness was less sensitive for adverse outcomes in older adults (sensitivity 0.58 in ≥ 60 vs. 0.73 in 18-39 and 0.73 in 40-59), while rebound tenderness was highly specific across ages (specificity 0.98, 0.96, 0.98). The number of potential diagnoses to consider rose with age.
Conclusion: In this cohort, CT use and positivity increased with age and key exam findings (e.g., tenderness) being less informative in older adults, despite similar reported clinician pretest suspicion. These results support age-aware imaging decisions and motivate reframing ED abdominal pain as a geriatric-specific chief complaint.
(© 2026 The Author(s). Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)
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Grant Information: K23 AG080061 United States AG NIA NIH HHS
Entry Date(s): Date Created: 20260511 Date Completed: 20260716 Latest Revision: 20260716
Update Code: 20260717
PubMed Central ID: PMC13158444
DOI: 10.1111/acem.70299
PMID: 42108559
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1553-2712
DOI:10.1111/acem.70299