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Background <p>Accurate assessment of symptom onset is crucial for diagnosing acute abdominal pain, particularly to identify life-threatening conditions such as rupture, dissection, vascular occlusion, torsion, or perforation. However, the optimal method for evaluating pain onset remains unclear.</p> Objective <p>To compare the diagnostic performance of two history-taking approaches for evaluating pain onset: sudden onset characterization, which asks whether the pain began suddenly, and time-to-peak assessment, which asks how long it took for the pain to reach maximum intensity, considering “instantaneous peak” responses as positive.</p> Design <p>Prospective diagnostic study at a single acute care hospital in Japan between December 2022 and October 2024.</p> Patients <p>A consecutive sample of adult patients presenting with abdominal pain of 7&#xa0;days’ duration or less in the emergency department was assessed.</p> Main Measures <p>The primary outcome was the presence of a target condition, defined as rupture, dissection, vascular occlusion, torsion, or perforation of an intra-abdominal organ, confirmed by contrast-enhanced computed tomography findings or clinical follow-up. Diagnostic measures including specificity, sensitivity, positive and negative predictive values, and likelihood and diagnostic odds ratios were calculated for each approach.</p> Key Results <p>Of the 629 patients (median age, 58&#xa0;years [interquartile range (IQR), 44–72&#xa0;years]; 48.5% male), 20 (3.2%) were diagnosed with a target condition. Specificity improved from 86.7% (95% confidence interval [CI], 83.8%-89.2%) with sudden onset characterization to 94.3% (95% CI, 92.1%-95.8%) with time-to-peak assessment (<i>P</i> &lt; .001). Sensitivity was 40.0% (95% CI, 21.9%-61.3%) for sudden onset characterization and 30.0% (95% CI, 14.5%-51.9%) for time-to-peak assessment (<i>P</i> = .48).</p> Conclusions <p>Time-to-peak assessment demonstrated higher specificity without a significant loss of sensitivity compared with sudden onset characterization. This approach may assist in ruling-in critical intra-abdominal conditions in patients with acute abdominal pain. However, neither method alone is sufficient to rule-out life-threatening conditions.</p>

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Diagnostic Performance of Onset Characterization vs. Time-to-Peak Assessment in Acute Abdominal Pain

  • 期刊论文

  • 发表日期：

    2025年12月8日

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  • Toshihiko Takada,
  • Ryuji Suzuki,
  • Hiroshi Honjo,
  • Masayuki Miyajima,
  • Tadao Kubota,
  • Shunichi Fukuhara

摘要

Background

Accurate assessment of symptom onset is crucial for diagnosing acute abdominal pain, particularly to identify life-threatening conditions such as rupture, dissection, vascular occlusion, torsion, or perforation. However, the optimal method for evaluating pain onset remains unclear.

Objective

To compare the diagnostic performance of two history-taking approaches for evaluating pain onset: sudden onset characterization, which asks whether the pain began suddenly, and time-to-peak assessment, which asks how long it took for the pain to reach maximum intensity, considering “instantaneous peak” responses as positive.

Design

Prospective diagnostic study at a single acute care hospital in Japan between December 2022 and October 2024.

Patients

A consecutive sample of adult patients presenting with abdominal pain of 7 days’ duration or less in the emergency department was assessed.

Main Measures

The primary outcome was the presence of a target condition, defined as rupture, dissection, vascular occlusion, torsion, or perforation of an intra-abdominal organ, confirmed by contrast-enhanced computed tomography findings or clinical follow-up. Diagnostic measures including specificity, sensitivity, positive and negative predictive values, and likelihood and diagnostic odds ratios were calculated for each approach.

Key Results

Of the 629 patients (median age, 58 years [interquartile range (IQR), 44–72 years]; 48.5% male), 20 (3.2%) were diagnosed with a target condition. Specificity improved from 86.7% (95% confidence interval [CI], 83.8%-89.2%) with sudden onset characterization to 94.3% (95% CI, 92.1%-95.8%) with time-to-peak assessment (P < .001). Sensitivity was 40.0% (95% CI, 21.9%-61.3%) for sudden onset characterization and 30.0% (95% CI, 14.5%-51.9%) for time-to-peak assessment (P = .48).

Conclusions

Time-to-peak assessment demonstrated higher specificity without a significant loss of sensitivity compared with sudden onset characterization. This approach may assist in ruling-in critical intra-abdominal conditions in patients with acute abdominal pain. However, neither method alone is sufficient to rule-out life-threatening conditions.