Stephen Colucciello, MD, FACEP
Professor of Emergency Medicine, University of North Carolina School of Medicine-Charlotte Campus,
When we first published Emergency Medicine Practice 20 years ago, emergency clinicians were becoming skeptical of established dogma, which was often based on an ?expert? who defined best practices; otherwise known as ?eminence-based? medicine. For example, abdominal pain patients were never to get opioids, oral contrast should always be used for abdominal CT scans and the rectal exam was essential in the abdominal pain workup.
Instead of blindly accepting such ?textbook facts?, we created Emergency Medicine Practice to advance an evidence-based approach. Evidence-based medicine depends upon the best available evidence, while incorporating personal experience and individual patient values. The size and quality of the study, the research methodology, and the reproducibility of results matters in assessing practice validity.
For Emergency Medicine Practice?s 20th anniversary, we turn back to our roots and revisit and revive our very first issue on abdominal pain. I understand from EB Medicine that hundreds ? if not thousands ? of emergency clinicians have said this course has aided them in their training and practice in the 20 years since its publication. The editors tell me it is oft-referenced even to this day.
Abdominal pain is one of the complaints seen most frequently in the ED, and the degree of pathology runs from the mundane to catastrophic. Unfortunately, the severity of illness is easily overlooked, especially in the elderly and immunosuppressed. Identifying the high-risk patient is crucial to avoiding a life-threatening diagnostic mistake.
There are many changes in best practices for assessing patients with abdominal pain compared to 20 years ago. Bedside ultrasound by the emergency provider is certainly revolutionizing ED practice. Radiation-reduction strategies are also becoming more commonplace. MRI is a growing modality, especially in pregnant women with suspected appendicitis. In the past two decades, we have learned that oral contrast provides no additional benefit to IV contrast in abdominal CT scans (with some exceptions). We also have seen a dramatic decrease in abdominal plain films and a corresponding increase in abdominal CT scans, especially in the elderly.
In the end, all the thinking, research, peer reviewing, and thought-provoking discussions that go into each issue of Emergency Medicine Practice are to ensure that every topic makes a difference in your diagnostic or treatment routine. I would be honored if you change your daily practice after reading this new edition of ?Assessing Abdominal Pain In Adults.?
Stephen Colucciello MD
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Last Updated on November 2, 2021