examinations, oſten with poor sensitivity and specificity (for example full blood count and CRP), makes their use in the community for urgent cases less helpful and may delay an appropriate admission.
To admit or not admit Te decision to admit a patient with acute abdominal pain, and to even form a definitive diagnosis, can be a very easy one. Classical appendicitis or an acute perforated duodenal ulcer may be obvious, but the presentation of retro-caecal appendicitis or a diverticular perforation can be difficult. Te safe handling of the patient is paramount and on occasion this will lead to admission where little is subsequently found. Te decision not to admit requires
consideration of appropriate follow-up and possibly laboratory or other tests. Safety netting is crucial. A patient with acute abdominal pain not admitted but ill enough to require reassessment the same day (unless a child) probably does need admission – not least because a surgeon assessing such patients regularly will have greater current experience than most GPs. Today most hospitals have an acute
ultrasound service for both general surgical and gynaecological purposes. Whether patients with a classical presentation require such investigation is a different story for commissioners. But as a GP, I will continue to be guided by my patient’s history, examination findings and on occasion intuition. Tis is likely to provide the best care for my patients and allow me to sleep at night – but if something does turn out wrong I will have a defensible stance.
Dr Jonathan Berry is a general practitioner in Trafford and a healthcare management consultant
Brekke M, Eilertsen R K. Acute abdominal pain in general practice: tentative diagnoses and handling. A descriptive study. Scand J Prim Health Care. 2009; 27(3): 137–140
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