Emergency department diagnosis of abdominal disorders in the elderly

To assess the accuracy of emergency department (ED) provisional diagnosis (ProDx) as compared with the hospital discharge diagnosis (HDDx) and the impact on hospital morbidity and mortality among nonelderly and elderly persons presenting with acute nontraumatic abdominal complaints, a retrospective review was conducted of 1,863 nonelderly (younger than 65 years) and 428 elderly (65 years or older) adults admitted to a university hospital from its ED. The sensitivity/specificity of the ProDx was 82%/86% for patients younger than 65 versus 68%/76% for those 65 or older. When the ProDx and HDDx did not agree, the overall disease-related morbidity was 16% for patients younger than 65 versus 45% for those 65 or older (P< .02). There were no differences in mortality based on agreement of the ProDx and HDDx. Prospective studies to determine the factors that are most useful in the ED diagnosis of acute nontraumatic abdominal disorders in the elderly are needed to improve the accuracy of diagnosis and reduce the incidence of morbidity in this high-risk group.