Title

The effect of use of a structured data collection form on the accuracy of diagnosing causes of acute abdominal pain

Date of Award

6-11-2012

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

Department

General Surgery (East Africa)

Abstract

Background: Initial assessment of acute abdominal pain by a clinician is the cornerstone to appropriate management since it determines rapidity and appropriateness of intervention. A poor initial assessment may lead to incorrect assumptions about diagnosis. Standardized forms have been suggested as one way of harmonizing the initial assessment therefore improving diagnostic accuracy of acute abdominal conditions and reducing over-reliance on investigations.

Objectives: To determine the extent to which use of a structured data collection form (SDCF) affected the diagnostic accuracy of acute abdominal pain, time to disposition from the accident and emergency, hospital stay and cost of investigations.

Methodology: A before and after study carried out from October 2011 to March 2012 of patients aged 13 and above presenting with acute abdominal pain in the emergency department (ED) of Aga Khan University hospital. Patients clerked by ED physicians using conventional history taking and examination between October and December 2011 were compared to a second group clerked after the introduction and by use of a structured data collection form (January – March 2012) for proportion of correct diagnosis at initial encounter and time to disposition from the ED. Data were compiled in MS-Excel spreadsheets and analyzed using SPSS v16. P value of <0.05 was considered significant

Results: The diagnostic accuracy was 58% and 43% before and after the introduction of the structured data collection form respectively (p=0.088). For surgical patients, diagnostic accuracy was 77% before and 31% after the introduction of the form (p=0.018). The emergency department disposition time (EDt) was 2½ hours before the introduction of the form and 2 hours 42 minutes after its introduction (p 0.452). The negative appendectomy rate was 18% before the intervention and nil after. The number of investigations averaged 3.25 and 3.49 (p=0.542) while the cost of tests averaged KShs 4315 vs. 6530 (p=0.368) in Period 1 and 2 respectively.

Conclusions: The structured form did not improve the accuracy of diagnosing the causes of acute abdomen, the disposition time from the ED or the cost of investigations.

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