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Chirurgie 1. Juli 2015

Long-term follow-up of patients diagnosed with nonspecific abdominal pain (NSAP): identification of pathology as a possible cause for NSAP

Background: Nonspecific abdominal pain (NSAP) accounts for 40 % of all general surgical admissions. Data suggest that conditions such as irritable bowel syndrome and gynaecological pathologies can be misdiagnosed as NSAP. Delayed diagnosis and management can cause increased morbidity. Our aim was to follow-up a cohort of patients with an initial diagnosis of NSAP to determine their eventual diagnosis.

Method: Hospital episode statistic (HES) data were reviewed to identify 100 acute surgical admissions coded as NSAP at discharge between January and December 2008. Medical records were systematically reviewed over a 3-year follow-up period to identify further investigations, operations and any eventual diagnoses in patients who fulfilled NSAP criteria. General practitioners were contacted to evaluate any further GP surgery visits and hospital referrals for this cohort of patients.

Results: A total of 59 were incorrectly coded as NSAP; only 41 fulfilled the criteria of NSAP at discharge from the initial acute admission. The majority of patients correctly diagnosed as NSAP were female (71 %) individuals. Median age across both genders was 25.7 years (interquartile range 19.4–37.7 years). At three yearly follow-up, 54 % of patients appropriately labelled as NSAP were diagnosed with a specific pathology.

Conclusion: This study highlights that around half of patients correctly labelled with NSAP were subsequently diagnosed with a specific pathology. Our results suggest that patients diagnosed with NSAP should be followed up to avoid additional morbidity from misdiagnosis. Furthermore, the current coding system for NSAP needs to be modified.

Mr. H.S. Watson, Mr. A.J. Cockbain, Dr. J.C.K. Wong, Dr. J. Stallard, Mr. S. Anwar, European Surgery 3/2015

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