Non-specific abdominal pain in elderly patients discharged from the emergency department: frequency, outcomes and risk-factors for adverse events (EDEN-43 study)

doi:10.21203/rs.3.rs-4838136/v1

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Non-specific abdominal pain in elderly patients discharged from the emergency department: frequency, outcomes and risk-factors for adverse events (EDEN-43 study)

https://doi.org/10.21203/rs.3.rs-4838136/v1

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Objective: To determine how frequent the diagnosis of non-specific abdominal pain (NSAP) is among elderly patients discharged from emergency departments (EDs), investigate short-term outcomes and look for factors related to adverse outcomes.

Methods: We included all patients 65 years or older diagnosed with NSAP and discharged home after ED care in 52 Spanish EDs during a one-week period. Outcomes consisted of 7-day and 30-day all-cause death, 30-day ED reconsultation and hospitalization, and 30-day combined adverse events (AEs) (ED reconsultation, hospitalization or death). Selected sociodemographic and index episode data were investigated for their potential relationship with 30-day combined AEs.

Results: Among 25,557 elderly patients attended in EDs during the 1-week period, 19,026 were discharged home and 397 (2.1%) had NSAP as the final diagnosis. The 7-day and 30-day mortality were 0.3% and 1.5%, respectively. The 30-day ED reconsultation was 21.9% and the 30-day hospitalization was 16.4%. Thirty-day combined AEs were recorded in 22.9% of patients and were independently associated with comorbidity and functional impairment as well as the use of opiate and non-opiate analgesia and lack of laboratory and imaging studies in the ED during the index episode.

Conclusions: A diagnosis of NSAP at ED discharge is frequent in elderly patients and carries a risk of adverse short-term outcomes. Discharge of those patients should be cautious, especially in comorbid patients with limited functional capacity, those needing analgesia, particularly opiates, and patients discharged without laboratory and imaging studies.

elder

abdominal pain

non-specific abdominal pain

emergency department

risk factors

outcomes

reconsultation

hospitalization

death

Acute abdominal pain is a non-specific symptom of many diseases, accounting for 5–10% of all patients coming to emergency departments (ED) (1–3). Although in many cases a specific illness (sometimes a severe or life-threating disease) is finally diagnosed after the ED work up, some patients remain undiagnosed and are discharged home with a coded diagnosis of non-specific abdominal pain (NSAP). Due to the wide range of severity in NSAP, emergency physicians need to be well-versed in the identification of specific causes of abdominal pain and must ensure that patients diagnosed with NSAP are safely discharged after ED care. A recent analysis of 173,630 patients visiting a single Finish ED showed that 6.1% were discharged with a diagnosis of NSAP and only 3.0% of these patients revisited the ED during the following 48 hours (with the risk of revist decreasing with increasing age) and 0.7% required hospitalization. Of note, similar ED revisit rates were observed for patients discharged by surgeons and emergency physicians (4). Therefore, as NSAP is a diagnosis of exclusion, patients must be reassured that the condition is most likely benign or self-limiting before being sent home.

NSAP is even more challenging in older patients (65 years or older), as they have more atypical, subacute or oligosymptomatic presentations of abdominal processes. Moreover, comorbidity is more frequent, laboratory and imaging studies are sometimes unspecific, and morbidity and mortality are higher in aged populations (5–7). Accordingly, many authors have warned emergency physicians that they should order more tests and reduce the threshold for hospital admission in elderly patients, since the risk of pathological findings in a return visit has been described as being relatively high among patients discharged with NSAP (8, 9).

However, few studies have investigated the frequency of the diagnosis of NSAP in elderly patients discharged home from the ED and their outcomes during the short-term follow-up, as most studies have only focused on the final specific diagnoses in the ED and on hospitalized patients (10). A Swedish study showed that the preliminary diagnosis in the ED and the discharge diagnosis were less reliable in elderly than in younger patients complaining of abdominal pain, and the elderly population more often had specific organic disease and arrived at the ED after a longer history of abdominal pain (11). Another study showed that 7% of ED visits by older adults (≥ 65 years) were for abdominal pain, and they had a lower probability of being triaged to the high emergent acuity categories on arrival (12). However, none of these studies followed patients discharged from the ED and no data on the outcomes of elderly patients was reported. Therefore, the objective of the present study was to assess the frequency of the diagnosis of NSAP among elderly patients discharged from the ED in a large sample of unselected consecutive older patients included in the EDEN (Emergency Department and Elder Needs) registry of Spanish EDs (13), as well as investigate short-term outcomes and look for factors related to adverse outcomes.

The EDEN registry

The primary objective of the EDEN registry is to increase knowledge about socio-demographic, organizational, baseline, clinical care and evolutionary aspects of the population ≥ 65 years consulting in Spanish EDs. To this end, the EDEN retrospective multipurpose registry was designed to include all patients who consulted in 52 Spanish EDs (17% of EDs of the Spanish public network covering around 25% of the Spanish population) between April 1 and 7, 2019 (7 days). There was no reason for exclusion, and the EDs included all patients seen during the study period regardless of the reason for consultation. More than 200 primary variables related to patients and ED episodes were recorded by consulting patients’ medical records. Extensive details of the EDEN registry have been published in detail previously (14–16).

The design of the EDEN-43 study

The EDEN-43 study was designed to analyze the frequency, outcomes and factors related to short-term adverse events of patients discharged from the ED with a diagnosis of NSAP. The diagnosis of NSAP was captured using the ICD-10 code R10.9 and was verified by reviewing patients’ medical reports. We excluded patients diagnosed with NSAP after ED care who were finally hospitalized, as well as patients discharged home in whom, in addition to the diagnosis of NSAP, another specific diagnosis able to cause NSAP had been also coded in the discharge report.

We recorded 9 independent variables that could influence outcomes, which included 4 baseline sociodemographic characteristics (age, sex, comorbidity assessed by the Charlson Comorbidity Index -CCI-, and functional dependence assessed by the Barthel Index -BI-) and 5 variables related to ED management during the index episode (use of non-opiate and opiate analgesia, laboratory and imaging studies, and extended patient observation in the ED). We limited the number of independent variables to 9 because we expected the number of cases with NSAP included in the analysis to be less than 500, and the number of events (30-day combined adverse events) to be around 20%, making the total number of foreseeable events less than 100. As we wanted to include all the independent variables as covariates in the multivariate model, by including only 9 variables the number of events had to be at least 90 and this would probably be achieved under the conditions of the EDEN-43 study and the final model would not be overfitted.

Outcomes

We investigated 7-day and 30-day all-cause mortality, 30-day ED revisit (related and unrelated to the index episode) and 30-day hospitalization (related and unrelated). In all cases, time 0 was set at the day that the patient was discharged home. We also created the 30-day combined adverse event variable, which was formed by all-cause ED revisit, all-cause hospitalization or all-cause death. This outcome was used to investigate the potential association of independent variables with short-term outcomes. All outcomes were locally adjudicated by the principal investigator of the center, with no external review.

Statistical analysis

Quantitative variables are expressed as median and interquartile range (IQR), and qualitative variables as the number of cases and percentages. The magnitude of association between independent variables and outcome (30-day combined adverse event) was estimated using logistic regression, first unadjusted for every independent variable individually considered, and thereafter in an adjusted multivariate model putting all the independent variables together. No replacement of missing data was carried out, as we expected that the number of missing values would be very low. Results are expressed as odds ratio (OR) with 95% confidence interval (CI). Statistical significance was accepted if the 95% CI of the OR excluded the value 1. All the analyses were performed with the SPSS package, version 29 (IBM, Armonk, New York, USA).

Ethics

The EDEN project was approved by the Clinical Research Ethics Committee of the Hospital Clínico San Carlos de Madrid, Spain (protocol HCSC/22/005-E). Due to the non-interventional design of the registry, Spanish legislation allows central Ethical Committee approval, accompanied by notification to the local Ethical Committees. Due to the retrospective and non-interventional design of the EDEN project, patient informed consent was waived. The present study was carried out in strict compliance with the principles of the Declaration of Helsinki.

Among 25,557 patients attended in the participating EDs, 19,026 were discharged home and 397 had NSAP as the only final diagnosis (1.6% of all attended patients, 2.1% of discharged patients) (Fig. 1). The median age was 75 years (IQR: 70–82) and 43.0% were males. Comorbidity (CCI > 0 points) was observed in 68.8% of cases, and 11% had severe comorbidity (CCI > 4 points). Impairment in functional capacity (BI < 100 points) was observed in 20.4% of cases, with 3.5% having severe or total dependence (< 60 points). Analgesic drugs were provided in 56.5% of cases (92.4% intravenously), with 4.8% of cases receiving opiates. Patients were discharged with no laboratory or imaging studies in 9.6% of cases and without an observation period in the ED in 81.9% of cases. The remaining clinical data are shown in Table 1.

Table 1

Sociodemographic and management characteristics of elderly patients discharged from the emergency department with a diagnosis of non-specific abdominal pain.
	All patients N = 397 n (%)	Missing data n (%)
Sociodemographic data
Age, years [median (IQR)]	75 (70–82)	0 (0)
Sex male	167 (43.0)	6 (1.5)
Charlson comorbidity index, points [median (IQR)]	1 (0–3)	0 (0)
Functional dependence (Barthel index < 100 points)	95 (23.9)	0 (0)
Management in the ED
Treated with non-opiate analgesia during ED stay	220 (55.7)	2 (0.5)
Treated with opiates during ED stay	19 (4.8)	0 (0)
Discharged without blood/urine analyses	44 (11.1)	1 (0.3)
Discharged without image studies (X-ray, US, CT scan)	114 (28.8)	1 (0.3)
Discharged after an observation period	76 (19.1)	0 (0)
IQR: interquartile range; ED: emergency department; US: ultrasound, CT: computerized tomography

The 7-day and 30-day mortality were 0.3% and 1.5%, respectively. Overall, 30-day ED reconsultation was 21.9% (13.9% related to the index episode) and 30-day hospitalization was 16.4% (6.7% related to the index episode). A 30-day combined adverse event was recorded in 22.9% of patients (Table 2).

Table 2

Outcomes of elderly patients discharged from the emergency department with the diagnosis of non-specific abdominal pain.
	N = 397 n (%)	Missing data n (%)
7-day all-cause death	1 (0.3)	2 (0.5)
30-day all-cause death	6 (1.5)	2 (0.5)
30-day ED reconsultations	85 (21.9)	8 (2.0)
Related to the index episode	54 (13.9)	8 (2.0)
Not related to the index episode	31 (8.0)	8 (2.0)
30-day ED hospitalization	64 (16.4)	7 (1.8)
Related to index the episode	26 (6.7)	7 (1.8)
Not related to the index episode	38 (9.7)	7 (1.8)
30-day combined adverse event	88 (22.9)	13 (3.3)
ED: emergency department

The frequency of 30-day combined adverse events was greater in patients with comorbidity and impaired functional capacity, in patients in whom analgesia with opiates was needed during the index episode and in those managed without laboratory and imaging studies during ED stay. The adjusted analysis showed that all these variables were independent risk factors for combined adverse events, as well as the use of non-opiate analgesia (Table 3). Age, sex and extended ED observation were not associated with adverse events.

Table 3

Analysis of risk factors for 30-day combined adverse events of elderly patients discharged from the emergency department with a diagnosis of non-specific abdominal pain.
	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
Sociodemographic data
Age (per each year)	1.00 (0.97–1.03)	0.99 (0.95–1.03)
Sex male	1.42 (0.88–2.30)	1.39 (0.82–2.37)
Charlson Comorbidity Index (per each point)	1.25 (1.13–1.38)	1.20 (1.08–1.34)
Functional dependence (Barthel Index < 100 points)	1.98 (1.18–3.32)	2.35 (1.24–4.45)
Management in the ED
Treated with non-opiate analgesia during ED stay	1.46 (0.90–2.39)	1.77 (1.01–3.11)
Treated with opiates during ED stay	3.22 (1.26–8.19)	3.25 (1.18–8.93)
Discharged without blood/urine analyses	2.49 (1.28–4.83)	2.71 (1.20–6.15)
Discharged without imaging studies (X-ray, US, CT scan)	1.78 (1.08–2.94)	1.91 (1.02–3.58)
Discharged after an observation period	0.99 (0.54–1.81)	1.19 (0.57–2.18)
ED: emergency department; OR: odds ratio; CI: confidence interval; US: ultrasound; CT: computerized tomography

The EDEN-43 study found that around 2% of elderly (65 years or older) coming to ED patients are given a diagnosis of NSAP at ED discharge. Although short term-mortality is low, the risk of other adverse events, such as ED reconsultation, hospitalization or death, is relatively high. Moreover, the EDEN-43 study defines certain patient- and process-related risk conditions that must be considered by emergency physicians to enhance safety measures and closer follow-up. In general, greater caution must be given to highly comorbid patients with limited functional capacity, as well as to those needing analgesia (especially opiates) during ED stay and in patients discharged directly home from ED without laboratory and imaging studies.

It is to be expected that elderly patients with NSAP and high comorbidity are at increased risk for worse short-term outcomes because some comorbidities included in the CCI are abdominal diseases (such as liver cirrhosis or peptic ulcer) or comorbidities that can indirectly increase the risk of abdominal complications (such as ischemic bowel disease in patients with diabetes mellitus and vascular comorbidities; or retroperitoneal or peritoneal cancer infiltration in patients with solid tumors or lymphoma). Conversely, the relationship between functional impairment and adverse events does not appear to be so evident. However, care complexity, which is increased in elderly patients with functional decline, is a factor associated with a higher rate of ED revisit (17) and this general effect could have been present in patients with NSAP, leading to the increase in adverse events observed.

The use of analgesia in patients with undiagnosed NSAP has been largely discussed for many decades and, although the literature addressing early pain relief for NSAP is weak, it suggests that analgesia is safe (18). A review of the literature of common etiologies and the management of acute abdominal pain in the general adult population and special patient populations seen in the ED revealed that intravenous administration of paracetamol, dipyrone or piritramide are currently the analgesics of choice in this clinical setting, and combinations of non-opioids and opioids should be administered in patients with moderate, severe or extreme pain (19). However, analgesia can be more difficult to titrate in older patients and some fears held by emergency physicians about its use could, in some cases, limit proper administration. In fact, in a very recent study of a consecutive series of patients with abdominal pain seen in the ED, advanced age was the only demographic variable associated with prolonged time to initial analgesia (20). This hypothetical reluctance of emergency physicians about analgesic administration in elderly patients with abdominal pain seems to be justified to some extent, as our results show that when an older patient consulting to the ED is finally discharged without a specific diagnosis (i.e., with a diagnosis of NSAP), the risk of adverse outcomes is increased if analgesia, especially opiates, are provided. Future studies specifically designed to investigate the effect of analgesia on outcomes of patients with NSAP, as well as in patients attending the ED in general, are needed to respond to this still unanswered question.

Two different types of biomarkers are applied for abdominal pain evaluation: those signaling the specific nosology (i.e., lipase in pancreatitis) and those indicating unspecific inflammation and the potential existence of a serious illness not just limited to abdominal processes (i.e., leukocyte count or C-reactive protein -CRP-) (21). Although the opportunity to approach patients with NSAP based on biomarkers is easily available in every ED, more than 10% of patients included in the EDEN-43 study were discharged without laboratory studies, and this was associated with a higher frequency of adverse events. Probably, a more generalized use of laboratory studies in elderly patients before discharge would diminish such adverse events. Likewise, similar findings were found regarding the use of imaging studies: nearly 30% of cases were discharged with no imaging study and this was also associated with increased adverse events during the follow-up period. Although there is consensus that guidelines should be followed when ordering imaging studies for patients with acute abdominal pain to minimize unnecessary patient radiation exposure, delays in diagnosis and definitive patient management and costs (22), the number of plain X-rays ordered in the ED is still high, as well as the number of CT scans, with age being one of the most consistent factors associated with overuse (23). Alternatively, ultrasonography is increasingly used in the ED by emergency physicians to assess NSAP. A recent trial demonstrated that systematic ultrasonography studies (based on the POCUS protocol) in elderly patients with NSAP did not improve the rate of diagnostic accuracy in unselected patients presenting to the ED (24). Conversely, another recent study, not limited to elderly patients, investigated the factors associated with the absence of complications in patients hospitalized because of NSAP and reported that incorporating a negative CRP result and a negative imaging study could be utilized to avoid unnecessary admissions of patients diagnosed with NSAP in the ED (25).

Finally, we failed in demonstrate that age and sex were related to adverse outcomes. Indeed, diagnostic errors might be made in not only individuals with very advanced age (5–7), but also in patients older than 40 presenting abdominal pain, who are more prone to returning to the ED within the following 72 hours more frequently than patients younger than 40 (26). Therefore, the influence of our neutral results of age on 30-day combined adverse outcomes are somewhat surprising. Conversely, the lack of influence of sex on outcomes found in our study is aligned with a previous study reporting no difference in management and diagnoses between older men and women who presented in the ED with abdominal pain (27). Neither did we note any effect of extended observation in the ED before patient discharge on the risk of adverse events. This could hypothetically be due to a balance of the opposite effect of, on one hand, the benefit of extended observation in limiting medical errors and, on the other hand, the fact that the most complex patients, who are probably at higher risk of further complications, were selected for this observation. In any case, NSAP is actually one of the well-defined processes for ED observation unit admission and the use of extended observation in the ED is recommended for unclear cases (28).

The EDEN-43 study has some limitations. First, the 52 participating EDs were not chosen at random but rather expressed their interest in participating. However, the broad representation both territorially and in terms of typology (including academic and non-academic, urban and rural hospitals, with high and low ED activity) means that bias in this regard is likely small. Second, the EDEN-43 study is exploratory in nature. No previous size calculation was performed and, accordingly, the statistical power to find significant differences associated with some characteristics was low. Nonetheless, despite the moderate sample size, the EDEN-43 study was able to detect several patient- and process-related circumstances associated with adverse outcomes. Third, we had to limit our analysis to 9 independent variables (4 patient-related and 5 process-related) and it is possible that the associations we found may be influenced by other factors not covered in the cohort design. Among these factors, patient frailty is a key aspect to be measured in elderly patients, and although we recorded comorbidity and dependence as subrogates of frailty, complete assessment of frailty in the ED was not recorded (29, 30). Fourth, we used the final codified diagnosis in the ED and, despite we looked for a specific diagnosis in the medical reports, this means that the findings may be conditioned by certain physician bias when they codify. Fifth, the inclusion of patients in the EDEN cohort was done by episodes rather than by patients, and some episodes may correspond to the same patient. However, given that the inclusion period was very short (7 days), the likelihood of a repeat visit by a particular patient was very low.

This retrospective multicenter Spanish cohort study shows that a diagnosis of NSAP at ED discharge is given in around 2% of elderly patients and carries a risk of short-term adverse outcomes. ED discharge of elderly patients with NSAP should be cautious, especially in comorbid patients with limited functional capacity, those needing analgesia, particularly opiates, and patients discharged without laboratory and imaging studies.

Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976;131:219–223.
Stone R. Acute abdominal pain. Lippincotts Prim Care Pract. 1998;2:341–357.
Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med. 1995;13:301–303.
Saaristo L, Ukkonen MT, Laukkarinen JM, Pauniaho SLK. The rate of short-term revisits after diagnosis of non-specific abdominal pain is similar for surgeons and emergency physicians - results from a single tertiary hospital emergency department. Scand J Trauma Resusc Emerg Med. 2020; 28: 63.
de Dombal FT. Acute abdominal pain in the elderly. J Clin Gastroenterol. 1994;19:331–335.
Lewis LM, Banet GA, Blanda M, Hustey FM, Meldon SW, Gerson LW. Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. J Gerontol A Biol Sci Med Sci. 2005;60:1071–1076.
Marco CA, Schoenfeld CN, Keyl PM, Menkes ED, Doehring MC. Abdominal pain in geriatric emergency patients: variables associated with adverse outcomes. Acad Emerg Med. 1998;5:1163–1168.
Pappas A, Toutouni H, Gourgiotis S, Seretis C, Koukoutsis I, Chrysikos I, et al. Comparative Approach to Non-Traumatic Acute Abdominal Pain Between Elderly and Non-Elderly in the Emergency Department: A Study in Rural Greece. J Clin Med Res. 2013; 5: 300–304.
Ravn-Christensen C, Qvist N, Bay-Nielsen M, Bisgaard T. Pathology is common in subsequent visits after admission for non-specific abdominal pain. Dan Med J. 2019;66:A5549.
Henden Çam P, Baydin A, Yürüker S, Erenler AK, Şengüldür E. Investigation of Geriatric Patients with Abdominal Pain Admitted to Emergency Department. Curr Gerontol Geriatr Res. 2018;2018:9109326.
Laurell H, Hansson LE, Gunnarsson U. Acute abdominal pain among elderly patients. Gerontology. 2006;52:339-44.
Friedman AB, Chen AT, Wu R, Coe NB, Halpern SD, Hwang U, et al. Evaluation and disposition of older adults presenting to the emergency department with abdominal pain. J Am Geriatr Soc. 2022;70:501-511.
Miró O, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Llorens P, Jiménez S, et al. Sociodemographic characteristics, functional status, and health resource use of older patients treated in Spanish emergency departments: a description of the EDEN cohort. Emergencias. 2022; 34:418-27.
Miró Ò, Osorio GI, Alquézar-Arbé A, Aguiló S, Fernández C, Burillo G, et al. Sex- and age-related patterns in the use of analgesics in older patients in the emergency department. Eur J Emerg Med. 2024;31:108-117.
Moyano García R, Piñera-Salmerón P, Jacob J, González del Castillo J, Montero-Pérez FJ, Alquézar-Arbé A, et al. Clinical course in older patients diagnosed with syncope treated in Spanish emergency departments: results from the Emergency Department and Elder Needs-17 study. Emergencias. 2024;36:281-9.
Artajona L, García-Martínez A, Aguiló S, Burillo-Putze G, Alquézar-Arbé A, Fernández C, et al. Influence of income on in-hospital mortality in older adults during the first wave of the COVID-19 pandemic: results from the EDEN-33 study. Emergencias. 2023; 35:423-31.
Urbina A, Juvé-Udina ME, Romero-García M, Delgado-Hito P, González-Samartino M, Adamuz J. Care complexity factors associated with revisits to an emergency department. Emergencias. 2023;35:245-51
Thomas SH, Silen W. Effect on diagnostic efficiency of analgesia for undifferentiated abdominal pain. Br J Surg. 2003;90:5-9.
Falch C, Vicente D, Häberle H, Kirschniak A, Müller S, Nissan A, et al. Treatment of acute abdominal pain in the emergency room: a systematic review of the literature.Eur J Pain. 2014;18:902-13.
Bloom B, Fritz CL, Gupta S, Pott J, Skene I, Astin-Chamberlain R, et al. Older age and risk for delayed abdominal pain care in the emergency department. Eur J Emerg Med. 2024; in press.
Clemente C, Fuentes Ferrer ME, Ortega Heredia D, Julián Jiménez A, Martín-Sánchez FJ, González del Castillo J. Usefulness of combining inflammatory biomarkers and clinical scales in an emergency department to stratify risk in patients with infections. Emergencias. 2024;36:09-16
Sreedharan S, Fiorentino M, Sinha S. Plain abdominal radiography in acute abdominal pain--is it really necessary? Emerg Radiol. 2014;21:597-603.
Tung M, Sharma R, Hinson JS, Nothelle S, Pannikottu J, Segal JB. Factors associated with imaging overuse in the emergency department: A systematic review. Am J Emerg Med. 2018;36:301-309.
Brau F, Papin M, Batard E, Abet E, Frampas E, Le Thuaut A, et al. Impact of emergency physician performed ultrasound in the evaluation of adult patients with acute abdominal pain: a prospective randomized bicentric trial. Scand J Trauma Resusc Emerg Med. 2024;32:15.
Panwar Y, Shan S, Owens L, Kang C, Hodgson R. Inefficient Admissions for Abdominal Pain Under an Acute General Surgical Unit. World J Surg. 2023;47:2401-2408.
Lin LT, Lin SF, Chao CC, Lin HA.Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain. Eur J Med Res. 2023;28:288.
Gardner RL, Almeida R, Maselli JH, Auerbach A. Does gender influence emergency department management and outcomes in geriatric abdominal pain? J Emerg Med. 2010;39:275-81.
Ross MA, Aurora T, Graff L, Suri P, O'Malley R, Ojo A, et al. State of the art: emergency department observation units. Crit Pathw Cardiol. 2012;11:128-38.
Aguiló Mir S. Identifying the frail patient in the emergency department: an urgent and necessary effort. Emergencias. 2023;35:165-6
Fernández Alonso C, Del Arco Galán C, Torres Garate R, Madrigal Valdés JF, Romero Pareja R, Bibiano Guillén C, et al. Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments. Emergencias. 2023; 35:196-204.

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Non-specific abdominal pain in elderly patients discharged from the emergency department: frequency, outcomes and risk-factors for adverse events (EDEN-43 study)

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Abstract

Figures

INTRODUCTION

METHODS

The EDEN registry

The design of the EDEN-43 study

Outcomes

Statistical analysis

Ethics

RESULTS

DISCUSSION

Limitations

Conclusion

References

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