Orient et al used a decision rule to evaluate men with abdominal pain. The rule was slightly modified by one developed by Wasson et al. The authors are from the University of Arizona.
The decision rule was developed in ambulatory men from the VA System.
Parameters:
(1) pain duration
(2) epigastric pain
(3) age
(4) pain features
(5) effect of pain on sleep
(6) abdominal and pelvic physical examination findings
(7) occult blood in stool
(8) vomiting
(9) weight loss
(10) past history
|
Parameter |
Finding |
Points |
|---|---|---|
|
pain duration |
pain for at least 6 months, OR at least 10 previous occurrence of pain |
-3 |
|
|
pain for less than 6 months AND less than 10 previous episodes |
0 |
|
epigastric pain and tenderness |
only finding |
-2 |
|
|
absent or other findings present |
0 |
|
age |
>= 60 years of age |
+4 |
|
|
< 60 years of age |
0 |
|
pain features |
pain is constant OR pain is unrelieved by food or medication |
+4 |
|
|
pain inconstant AND relieved by food or medication |
0 |
|
pain has affected sleep |
yes |
+3 |
|
|
no |
0 |
|
abdominal and pelvic exam findings |
mass, rigidity, rebound, distention, absent bowel sounds or an abnormal liver |
+3 |
|
|
negative examination |
0 |
|
stool testing for occult blood |
positive |
+3 |
|
|
negative |
0 |
|
vomiting since pain began |
yes |
+2 |
|
|
no |
0 |
|
change in weight |
unintentional weight loss >= 10 pounds |
+1 |
|
|
weight gain or no change or unintentional weight loss < 10 pounds or intentional loss |
0 |
|
history |
cancer, diverticular disease, pancreatitis, gallstones, or inflammatory bowel disease |
+6 |
|
|
negative history |
0 |
where:
• Removal of the gallbladder would seem to reduce the significance of a history of gallbladder disease.
• The time interval for weight loss is unspecified.
total score =
= SUM(points for all parameters) - 5
Interpretation:
• A score < 0 indicates a low likelihood of serious disease.
Limitations:
• Patients with peptic ulcer disease may be classified as low risk.
• Diseases outside of the abdomen and pelvis may present with abdominal pain. The score may indicate a low risk for serious abdominal disease yet the patient have a serious disease elsewhere.
Purpose: To determine if an ambulatory male patient with abdominal pain has potentially serious disease using the decision rule of Orient et al.
Specialty: Gastroenterology, Surgery, general
Objective: clinical diagnosis, including family history for genetics, criteria for diagnosis
ICD-10: R10,
