As accurate diagnosis—as opposed to a discharge or admission decision—becomes more pertinent to emergency medicine, a striking feature of abdominal pain becomes apparent: It is extremely difficult to make the correct diagnosis using only clinical findings and basic laboratory tests. When initial and final diagnoses are compared, diagnostic accuracy is reported as falling somewhere between 50 and 65 percent overall.15 It is clear that diagnostic error in adults with abdominal pain increases in proportion to age, ranging from a low of 20 percent if only young adults are considered, 15 to a high of 70 percent in the very elderly.16
In spite of a high diagnostic error rate, the discharge error rate (proportion of patients mistakenly sent home from the ED) is substantially lower, reported to be 1 percent or less in two series, increasing to 4 percent in patients >65 years old.5
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