Ulus Travma Acil Cerrahi Derg. 2008; 14(2): 118-124

Akut nonspesifik karýn aðrýlý olgularýn bir yýllýk prognozlarý, semptom ve bulgularýnýn tanýsal doðruluðu

Halil Özgüç¹, Nurþen Çakýn², Uður Duman^1
1Uludað Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý- Bursa
²Uludað Üniversitesi Týp Fakültesi,acil Týp Anabilim Dalý-bursa

AMAÇ
Nonspesifik karýn aðrýlý hastalarýn ayrýmýnda, hastalýk hikayesi, klinik bulgular, basit laboratuvar deðerlendirmelerinin tanýsal deðerini belirlemek ve bu hastalarýn uzun süreli takiplerini analiz etmektir.
GEREÇ VE YÖNTEM
Uludað Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý Acil Servisi’nde Kasým 2001 ile Kasým 2002 tarihleri arasýnda prospektif gözlem çalýþmasý gerçekleþtirildi. Altý yüz on karýn aðrýlý hasta, spesifik karýn aðrýsý (501 hasta) ve nonspesifik karýn aðrýsý (109 hasta) olarak gruplandýrýldý. Nonspesifik karýn aðrýlý hastalar 24 saat sonra takip deðerlendirmesi için çaðrýldýlar; 8., 15., 30. günler ile 1 yýl sonunda olmak üzere 4 takip görüþmesi için tekrar çaðrýldýlar. Ýki grubun bulgularý arasýnda istatistiksel deðerlendirme yapýldý.
BULGULAR
Lojistik regresyon analizinde daha önce benzer bir aðrý hikayesi varlýðý (odds oraný 1,88; p=0,009), bulantý (odds oraný 0,46; p=0,001), defans (odds oraný 0,24; p=0,024), ateþ ≤36,6°C (odds oraný 1,66; p=0,037), lökosit sayýmý ≤8700 (odds oraný 1,85; p=0,011), yaþ ≤39 (odds oraný 1,85; p=0,018), solunum hýzý ≤15 (odds ratio 3,19; p=0,00) anlamlý baðýmsýz tanýsal faktörlerdi. Bir yýllýk takip sürecinde hiçbir malinite saptanmadý.
SONUÇ
Acil servise akut karýn aðrýsý nedeniyle baþvuran olgularda baþvuru esnasýnda daha önce benzer bir aðrý hikayesi, bulantý, defans, ateþ >36,6°C, lökosit sayýmý >8700, yaþ >39, solunum hýzý >15 olan ve taburculuk sonrasý 24 saatte kalýcý-devamlý aðrýsý olan hastalarda spesifik bir neden olasýlýðý yüksektir.

Anahtar Kelimeler: Fiziksel inceleme bulgularý; nonspesifik karýn aðrýsý; karýn aðrýsý, bulgu; tanýsal deðerlendirme; takip çalýþmasý.

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Diagnostic accuracy of symptoms, signs and one-year prognosis of patients with acute non-specific abdominal pain: prospective survey

Halil Özgüç¹, Nurþen Çakýn², Uður Duman^1
1Uludag University Medical School, Department Of General Surgery- Bursa
²Uludag University Medical School, Department Of Emergency Medicine- Bursa

BACKGROUND
The aims of this study were to determine the diagnostic value of elements of the disease history, the clinical findings and basic laboratory examinations in differential diagnosis of the patients with nonspecific abdominal pain and to analyze the long-term survey of these patients.
METHODS
A prospective observational study was performed at the Department of General Surgery Medicine Faculty of Uludag University between November 2001 to November 2002. Based on the diagnosis reasons for abdominal pain, 610 patients were classified as being of specific abdominal pain (n=501) versus nonspecific abdominal pain (n=109). Patients with nonspecific abdominal pain were invited to a follow-up examination 24 hours later and 4 follow-up interviews were conducted on days 8, 15, 30 and at the end of 1 year. Statistical analyses were performed between findings of two groups.
RESULTS
In logistic regression analysis, presence of a history of similar pain (odds ratio 1.88; p=0.009), nausea (odds ratio 0.46; p=0.001), rigidity (odds ratio 0.24; p=0.024), fever ≤36.6°C (odds ratio 1.66; p=0.037), leukocyte count ≤8700 (odds ratio 1.85; p=0.011), age ≤39 years (odds ratio 1.85; p=0.018), respiratory rate ≤15 (odds ratio 3.19; p=0.00..) were significantly independent diagnostic factors. There was no malignancy during one-year follow-up period.
CONCLUSION
The possibility of a specific cause is higher in patients with history of a similar pain, nausea, rigidity, fever >36.6°C, leukocyte count >8700, age >39 years, respiratory rate >15 in admission and persistent pain 24 hours after discharge.

Keywords: Diagnostic evaluation; follow-up study; non-specific abdominal pain; symptoms; physical signs.

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