Abdominal pain in the elderly: use of temperature and laboratory testing to screen for surgical disease.

BACKGROUND AND OBJECTIVES: This study evaluated the usefulness of temperature, leukocyte count, and laboratory screening tests for abdominal pain to distinguish dischargeable from admittable illness and to distinguish admittable, nonsurgical disease from surgical disease in elderly patients (> or = 65 years) who present to the emergency department with acute (< 1 week) nontraumatic abdominal pain.

METHODS: A retrospective review was done of emergency department and hospital medical records of these patients from January 1, 1993-December 31, 1993, at a large, Midwestern tertiary care center with 65,000 annual patient visits to the emergency department.

RESULTS: Of 231 patients who met the inclusion criteria, 51 were discharged from the emergency department, 94 were admitted without subsequent operation, and 86 were admitted directly for operation or had an operation during hospitalization. For all factors, a statistically significant difference was seen between the patients discharged and those admitted. However, the presence or absence of abnormal test values (hemoglobin, alkaline phosphatase, aspartate aminotransferase, bilirubin, lactate, and the degree of fever and leukocytosis) did not distinguish those who were admitted and did not require operation from those with surgical disease. Surgical diagnoses and prevalence of surgical illness were similar to those observed in prior geriatric studies. A significant number (13%) of surgical patients presented with normal results for all screening tests.

CONCLUSIONS: Temperature and laboratory screening tests for evaluation of abdominal pain in the elderly do not differentiate admittable, nonsurgical disease from surgical disease. Physicians who evaluate elderly patients with acute abdominal pain must be aware that their clinical impression of surgical illness is of greater importance than laboratory tests in the decision to request special studies or surgical consultation.