Admit/Discharge Decision-making

If there is no evidence of a significant surgical pathology, the patient is pain free and has a normal examination then it is reasonable to discharge the patient home with clear advice on when to return. Patients with acute abdominal pain will normally be given appropriate safety netting advice before being discharged, for example to return if significant pain recurs or they become otherwise unwell.

It may also be appropriate to arrange a review 12-24 hours later, for example as a day attender to the Surgical Assessment Unit. Patients with suspected biliary colic who have pain that settles can often undergo USS followed by discharge or be brought back the next day for an USS.

Elderly patients and those with significant co-morbidity should be admitted in most cases as they are at much higher risk of serious pathology. An RCEM standard is that all patients over the age of 70 presenting with abdominal pain should have consultant sign off.

It is not uncommon to reassess a patient who initially presented with severe pain (eg. requiring morphine) to find them pain free with a soft abdomen. In these situations, remember that pain may recur. In general, any patient who has experienced pain requiring strong opiates is likely to need admission for observation and possible further investigations.

Learning Bite

Patients with abdominal pain discharged from the ED should have clear safety netting advice including when to return.