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Brooks D, Smiles JP, Murphy AP, Cowan T, Soeyland T, Hullick C, Arendts G. Assessment and management of older patients with abdominal pain in the emergency department. Emerg Med Australas 2024; 36:149-158. [PMID: 38176903 DOI: 10.1111/1742-6723.14361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Daniel Brooks
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - John P Smiles
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Andrew P Murphy
- Gosford Hospital, Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Timothy Cowan
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Torgrim Soeyland
- Port Macquarie Base Hospital, Mid-North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Caroyln Hullick
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle and Staff Specialist in Emergency Medicine, Belmont Hospital, Newcastle, New South Wales, Australia
| | - Glenn Arendts
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Newman DP, Holkup SM, Masi EL, Soto AT. A Novel Approach to Assessing and Conservatively Treating Anterior Cutaneous Nerve Entrapment Syndrome: A Case Study. Cureus 2023; 15:e44912. [PMID: 37814768 PMCID: PMC10560539 DOI: 10.7759/cureus.44912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
Anterior cutaneous nerve entrapment syndrome (ACNES) is a common source of chronic abdominal pain and is often underdiagnosed despite numerous and potentially invasive diagnostic evaluations and tests. We present a case report describing a novel, conservative, and non-invasive approach to diagnose and treat recurrent ACNES in a young and active patient. We describe a treatment-based diagnostic approach to confirm potential ACNES pain generators while recording pre- and post-treatment pain scores. After each maneuver, the patient was reassessed which allowed the working diagnosis to clinically evolve demonstrating the pathologic interrelationship between different skeletal structures and myofascial tissues contributing to irritation of the anterior cutaneous nerve. This treatment-based technique also made it possible to identify referred pain from a condition with overlapping symptoms originating from a different anatomic site. Treatment consisted of sequenced osteopathic manipulation techniques, active release techniques, instrument-assisted soft tissue mobilization, directional cupping, stretching, and strengthening exercises. The combination of sequenced treatments over the course of six physical therapy visits spanning 10 weeks resulted in 100% pain reduction and complete resolution of functional limitations. The patient was able to complete all work requirements and physical activity without pain. A sequenced treatment-based diagnostic approach to this case allowed us to more accurately identify all involved anatomic regions of pain and anatomic segments of pathology that were contributing to the abdominal pain or referring pain. No diagnostic imaging, invasive test, or injection was needed to properly diagnose and treat this case of ACNES. A proper understanding and application of osteopathic manipulation, active release techniques, instrument-assisted soft tissue mobilization, cupping, and exercises successfully resolved the contributing pain conditions and provided the patient important and useful tools and strategies to prevent recurrence.
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Affiliation(s)
- David P Newman
- Pain Management-Physiotherapy, Tripler Army Medical Center, Honolulu, USA
| | | | - Erica L Masi
- Pain Management, Tripler Army Medical Center, Honolulu, USA
| | - Adam T Soto
- Anesthesiology, Pain Management, Alexander T. Augusta Military Medical Center, Fort Belvoir, USA
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Hamdan M, Yang X, Mavura M, Saleh M, Kannani G, Haonan K, Al-Danakh A, Zhaohui X, Zezhong G, Hyokju R, Amado B, Yanying R, Xin C. Factors associated with delayed reporting for surgical care among patients with surgical acute abdomen attended at Muhimbili National Hospital: Tanzania. BMC Gastroenterol 2023; 23:59. [PMID: 36890435 PMCID: PMC9996925 DOI: 10.1186/s12876-023-02659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/24/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Surgical acute abdomen is a sudden onset of severe abdominal symptoms (pain, vomiting, constipation etc.) indicative of a possible life-threatening intra-abdominal pathology, with most cases requiring immediate surgical intervention. Most studies from developing countries have focused on complications related to delayed diagnosis of specific abdominal problems like intestinal obstruction or acute appendicitis and only a few studies have assessed factors related to the delay in patients with acute abdomen. This study focused on the time from the onset of a surgical acute abdomen to presentation to determine factors that led to delayed reporting among these patients at the Muhimbili National Hospital (MNH) and aimed to close the knowledge gap on the incidence, presentation, etiology, and death rates for acute abdomen in Tanzania. METHODS We conducted a descriptive cross-sectional study at MNH, Tanzania. Patients with a clinical diagnosis of the surgical acute abdomen were consecutively enrolled in the study over a period of 6 months and data on the onset of symptoms, time of presentation to the hospital, and events during the illness were collected. RESULTS Age was significantly associated with delayed hospital presentation, with older groups presenting later than younger ones. Informal education and being uneducated were factors contributing to delayed presentation, while educated groups presented early, albeit the difference was statistically insignificant (p = 0.121). Patients working in the government sector had the lowest percentage of delayed presentation compared to those in the private sector and self-employed individuals, however, the difference was statistically insignificant. Family and cohabiting individuals showed late presentation (p = 0.03). Deficiencies in health care staff on duty, unfamiliarity with the medical facilities, and low experience in dealing with emergency cases were associated with the factors for delayed surgical care among patients. Delays in the presentation to the hospital increased mortality and morbidity, especially among patients who needed emergency surgical care. CONCLUSION Delayed reporting for surgical care among patients with surgical acute abdomen in underdeveloped countries like Tanzania is often not due to a single reason. The causes are distributed across several levels including the patient's age and family, deficiency in medical staff on duty and lack of experience in dealing with emergency cases, educational level, working sectors, socioeconomic and sociocultural status of the country.
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Affiliation(s)
- Maryam Hamdan
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Xu Yang
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - M Mavura
- Department of General Surgery, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Mohammed Saleh
- Department allied, Health Science Zanzibar, Zanzibar, Tanzania
| | - George Kannani
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Kang Haonan
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Abdullah Al-Danakh
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xu Zhaohui
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Gong Zezhong
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Ri Hyokju
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Boureima Amado
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Ren Yanying
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Chen Xin
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China.
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Correction: Osterwalder et al. Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes. J. Clin. Med. 2020, 9, 899. J Clin Med 2023; 12:jcm12041403. [PMID: 36836243 PMCID: PMC9960859 DOI: 10.3390/jcm12041403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
In the original publication [...].
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ACEHAN S, SATAR S, GÜLEN M, TOPTAS FİRAT B, AKA SATAR D, TAŞ A. 65 yaş üstü hastalarda puanlama sistemlerinin şiddetli akut pankreatiti ve mortaliteyi erken öngörme açısından değerlendirilmesi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1121730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The aim of this study is to investigate the power of disease severity scores to predict the development of Severe Acute Pancreatitis (SAP) and mortality in the early period over 65 years old diagnosed with acute pancreatitis in the emergency department.
Materials and Methods: We calculated RANSON (on admission) and Computed Tomography Severity Index (CTSI) in addition to Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission to the emergency department.
Results: One hundred and sixty patients (46.9% over 80 years of age) were included in the study. We observed statistically higher length of hospitalization, longer duration of stay in the intensive care unit, SAP and higher mortality in patients over 80 years of age. When we examined the ROC curve, we determined that the AUC values of the BISAP score were highest in both SAP and mortality estimation (AUC: 0.911, 95% CI 0.861-0.962; AUC: 0.918, 95% CI 0.864-0.9722, respectively). Binary logistic analysis indicated a 4.7-fold increased risk for SAP and a 12.3-fold increased mortality for each unit increase in BISAP score value.
Conclusion: BISAP may be a good predictor for SAP and mortality estimation on admission to the emergency department in patients over 65 years of age with acute pancreatitis.
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Affiliation(s)
- Selen ACEHAN
- Adana City Training and Research Hospital, Department of Emergency Medicine
| | - Salim SATAR
- Adana City Training and Research Hospital, Department of Emergency Medicine
| | - Müge GÜLEN
- Adana City Training and Research Hospital, Department of Emergency Medicine
| | - Basak TOPTAS FİRAT
- Aksaray University Training and Research Hospital, Department of Emergency Medicine, Aksaray, Turkey
| | - Deniz AKA SATAR
- Adana City Training and Research Hospital, IVF Unit, Adana, Turkey,
| | - Adnan TAŞ
- Adana City Training and Research Hospital, Department of Gastroenterology, Adana, Turkey,
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Larsson G, Hansson P, Olsson E, Herlitz J, Hagiwara MA. Prehospital assessment of patients with abdominal pain triaged to self-care at home: an observation study. BMC Emerg Med 2022; 22:92. [PMID: 35659247 PMCID: PMC9164890 DOI: 10.1186/s12873-022-00649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients who call for emergency medical services (EMS) due to abdominal pain suffer from a broad spectrum of diseases, some of which are time sensitive. As a result of the introduction of the concept of 'optimal level of care', some patients with abdominal pain are triaged to other levels of care than in an emergency department (ED). We hypothesised that it could be challenging in a patient safety perspective. AIM This study aims to describe consecutive patients who call for EMS due to abdominal pain and are triaged to self-care by EMS clinicians. METHODS This was an observational study performed in an EMS organisation in Western Sweden during 2020. The triage tool Rapid Emergency Triage and Treatment System (RETTS), which included Emergency Signs and Symptom (ESS) codes, was used to find medical records where patients with abdominal pain have been triaged to self-care and 194 patients was included in the study. RESULTS Of total 48,311 ambulance missions, A total of 1747 patients were labelled with ESS code six (abdominal pain), including 223 (12.8%) who were given the code for self-care and 194 who were further assessed by the research group. Of these patients, 32 (16.3%) had a return visit within 96 hours due to the same symptoms and 11 (5.6%) were hospitalised. In six of these patients, the EMS triage was evaluated retrospectively and assessed as inappropriate. These patients had a final diagnosis of ruptured abdominal aneurysm (n = 1), acute appendicitis with peritonitis (n = 2) and acute pancreatitis (n = 3). All these patients required extensive evaluation and different treatments, including acute surgery, antibiotics and fluid therapy. CONCLUSION Amongst the 1747 patients assessed by EMS due to abdominal pain, 223 (12.8%) were triaged to self-care. Of the 194 patients who were further assessed, 16.3% required a return visit to the ED within 96 hours and 5.6% were hospitalised. Six patients had obvious time-sensitive conditions. Our study highlights the difficulties in the early assessment of abdominal pain and the requirement for an accurate decision support tool.
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Affiliation(s)
- Glenn Larsson
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Hansson
- NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, Sweden
| | - Emelie Olsson
- NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
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