BACKGROUND

The Society for Academic Emergency Medicine has launched an initiative called GRACE, which stands for Guidelines for Reasonable and Appropriate Care in the Emergency Department. The second iteration of these guidelines examine the issue of low-risk, recurrent abdominal pain in the emergency department (ED).¹ Abdominal pain is a very common chief complaint in emergency medicine, and its evaluation is relatively resource intensive, with imaging ordered in more than 50% of patients.² There is evidence that we overuse imaging in this population, as the rate of CT increased from 10% in 2001 to 22.5% in 2005, while the rate of hospital admission and diagnosis of important pathology such as appendicitis and diverticulitis remained unchanged.³ There is a small population of patients who make frequent visits to the ED for recurrent, undifferentiated abdominal pain.⁴ The cumulative risk of ionizing radiation from repeated CTs increases the risk of harm in this population, but that harm must be weighed against the possibility of a new acute diagnosis on any given ED visit.^{5, 6} Patients with repeated visits to the ED for the same complaint may warrant different management plans, as it seems irrational to repeat the same, previously fruitless investigations and treatments time and again. Emergency clinicians need evidence-based guidance on the management of these complex patients. With the publication of the GRACE-2 guidelines, Broder et al.¹ attempt to provide us with the best evidence around four key questions in the management of patients with low-risk, recurrent abdominal pain in the ED.

中文翻译：

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新闻热点：急诊科低风险、复发性腹痛

背景

学术急诊医学协会发起了一项名为 GRACE 的倡议，它代表急诊科合理和适当护理指南。这些指南的第二次迭代检查了急诊科 (ED) 中低风险、复发性腹痛的问题。¹腹痛是急诊医学中非常常见的主诉，其评估资源相对密集，超过 50% 的患者需要进行影像学检查。²有证据表明，我们在这一人群中过度使用影像学检查，因为 CT 率从 2001 年的 10% 增加到 2005 年的 22.5%，而入院率和重要病理（如阑尾炎和憩室炎）的诊断率保持不变。^3个有一小部分患者因反复发作的、未分化的腹痛而经常去急诊室就诊。⁴重复 CT 电离辐射的累积风险增加了该人群受到伤害的风险，但必须权衡这种伤害与任何给定的急诊就诊时新的急性诊断的可能性。^{5, 6}因同一投诉而多次就诊于急诊室的患者可能需要不同的管理计划，因为一次又一次地重复相同的、以前毫无结果的调查和治疗似乎是不合理的。急诊临床医生需要基于证据的指导来管理这些复杂的患者。随着 GRACE-2 指南的发布，Broder 等人。^1个试图为我们提供关于 ED 中低风险、复发性腹痛患者管理的四个关键问题的最佳证据。