# Rate and Outcomes of Second Visits to the ED Among Patients Discharged With Non-specific Abdominal Pain in a Tertiary Hospital in Saudi Arabia

## TL;DR

The study found that 7.4% of patients discharged with non-specific abdominal pain revisited the emergency department within three days with a different diagnosis, often acute cholecystitis.

## Contribution

The study identifies risk factors and outcomes for patients misdiagnosed with non-specific abdominal pain in Saudi Arabia, a gap in existing literature.

## Key findings

- 7.4% of patients discharged with NSAP revisited the ED within three days with a different diagnosis.
- Acute cholecystitis was the most common new diagnosis during second ED visits.
- Revisited patients were younger, had higher BMI, and more surgical history compared to non-revisited patients.

## Abstract

Background

It is well documented in the literature that the most common diagnosis for acute abdomen is nonspecific abdominal pain (NSAP). The context of NSAP in the literature is either (a) ranking it among other causes of acute abdomen or (b) addressing that some patients revisited the ED with a different diagnosis after being initially labeled with NSAP. These two contexts create a gap, as no article has discussed the characteristics of patients mislabeled with NSAP in KSA. In other words, what might be the risk factors making their presentation nonspecific? In this article, we discuss the characteristics of patients labeled with NSAP who revisited the ED within three days and were subsequently diagnosed with a different condition, if found.

Methodology

The study was a retrospective cohort study. Data were taken from case files at King Abdulaziz Medical City (KAMC), a tertiary hospital in Riyadh, Saudi Arabia, using the Best-Care system. All adults who attended the ED and were discharged with the diagnosis of NSAP (ICD code R10.4) between 2015 and 2023 were included. Patients were then tracked for 3 days, which is the cutoff commonly used in ED research. Statistical analysis was performed using R 4.3. Categorical variables were summarized using counts and percentages, and continuous variables (normal and non-normal) using mean ± SD and median/IQR. The chi-square test was used to assess associations, and logistic regression analysis was used to predict revisits. Only statistically significant variables were included, and hypothesis testing was performed at a 5% level of significance.

Results

A total of 932 patients were discharged from the ED with NSAP. Out of these, 69 (7.4%) revisited the ED within 3 days and received a different diagnosis. The study found significant age differences between the two groups: the median age was 40 years (IQR: 27-58) in non-revisited patients and 29 years (IQR: 21-42) in re-visited patients. A higher proportion of re-visited patients had a BMI over 25 (64.1% vs. 40.6%, p < 0.001). Surgical history also showed a significant difference, with 39.1% of re-visited patients having a history of abdominal surgery compared to 18.2% of non-revisited patients (p < 0.001). Acute cholecystitis was the most common diagnosis during the second visit, accounting for 32.3% of revisits, followed by appendicitis. Re-visited patients also showed a higher prevalence of hypothyroidism (13.4% vs. 1.27%) and a higher incidence of type 2 diabetes (8.96% vs. 1.27%).

Conclusion

This retrospective cohort study revealed several significant findings regarding factors associated with ED revisits following an initial discharge with a diagnosis of NSAP. The most common diagnosis identified during the second visit was acute cholecystitis.