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Nonspecific abdominal pain in the Emergency Department: malignancy incidence in a nationwide Swedish cohort study

Ferlander, Piaa; Elfström, Ceciliaa; Göransson, Katarinaa,b; von Rosen, Anettea,b; Djärv, Theresea,b

European Journal of Emergency Medicine: April 2018 - Volume 25 - Issue 2 - p 105–109
doi: 10.1097/MEJ.0000000000000409

Introduction The role of emergency physicians is to identify patients in need of immediate treatment, but also to identify symptoms indicative of serious, if not immediately life-threatening conditions.

Aim To assess whether symptoms described as nonspecific abdominal pain (NSAP) could be the first indication of an abdominal malignancy.

Materials and methods This was a nationwide registry-based cohort study of all patients discharged with NSAP from Swedish Emergency Departments (EDs) during the year 2011, based on Swedish patient registries of inpatient and outpatient care, and the cause of death registry, studying patients diagnosed with de novo cancer within a year after their NSAP discharge.

Results Of 24 801 patients discharged with NSAP in 2011, 2.2% were assigned a cancer diagnosis within 12 months. Almost 20% of patients diagnosed with a malignancy died within the year, and 16% of these deaths occurred within a month after the ED visit. The majority of patients with cancer were 60 years of age or older, and thus significantly older than the remaining NSAP patients. Patients with malignancies also had a greater number of comorbidities than the remaining NSAP patients (P<0.01).

Conclusion A small percentage of patients discharged with NSAP from Swedish EDs are diagnosed with a malignancy within a year. Patients aged 60 years or older and with comorbidities were over-represented in terms of developing malignancies after discharge. Emergency physicians should be aware of the fact that diffuse abdominal symptoms in elderly patients could be the first sign of an underlying malignancy and more liberally refer such patients for follow-up in primary care.

aDepartment of Emergency Medicine, Karolinska University Hospital

bDepartment of Medicine Solna, Karolinska Institute, Stockholm, Sweden

Correspondence to Therese Djärv, MD, PhD, Department of Medicine Solna, Karolinska Institute, SE-171 76 Stockholm, Sweden Tel/fax: +46 8 517 7000; e-mail:

Received February 2, 2016

Accepted April 22, 2016

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