Usefulness of history-taking in non-specific abdominal pain: a prospective study of 1333 patients with acute abdominal pain in Finland

Abstract

Background: Nonspecific abdominal pain is the commonest cause of a patient presenting to a doctor with abdominal pain of less than one week's duration. The differential diagnosis of NSAP is not always easy due to many similarities in the clinical presentation at onset and many cases may be misdiagnosed in the initial situation. To the Authors' knowledge, the diagnostic accuracy of history-taking is rarely considered in NSAP, and therefore the aim of the present study was to investigate the contribution of history-taking to correctly diagnosing NSAP in the clinical situation.

Patients and methods: The accuracy of clinical diagnosis of NSAP was studied in connection with the survey of acute abdominal pain by the Research Committee of the World Organization of Gastroenterology (OMGE). In an extension of the OMGE acute abdominal pain study, 1333 patients presenting with acute abdominal pain were included in the study. The clinical symptoms of each patient were recorded in detail, using a predefined structured data collection sheet, and the collected data were compared with the final diagnosis of the patients.

Results: The most significant symptoms of NSAP in univariate analysis were: vomiting (Usefulness Index, UI=0.11, Risk Ratio, RR=2.01), progression of pain (UI=0.10, RR=1.90), location of pain at diagnosis (UI=0.05, RR=1.75), intensity of pain (UI=0.05, RR=1.57) and previous indigestion (UI=0.05, RR=1.44). The sensitivity of the doctors' initial decision in detecting NSAP was 0.70, with a specificity of 0.83 and an efficiency of 0.77.

Conclusion: The results of this study do not support a specific link between any one clinical symptom and NSAP diagnosis. However, patients with midline pain, without any increase in pain and without vomiting, and those with weak or moderate pain tended to be at risk for NSAP.