Safety of early pain relief for acute abdominal pain.

OBJECTIVES--(a) to determine the efficacy of papaveretum in treating pain when administered early to patients presenting with acute abdominal pain and (b) to assess its effect on subsequent diagnosis and management. DESIGN--Prospective, randomised, placebo controlled study. SETTING--Walsgrave Hospital, Coventry. SUBJECTS--100 consecutive patients with clinically significant abdominal pain who were admitted as emergencies to a surgical firm. INTERVENTIONS--Intramuscular injection of up to 20 mg papaveretum or an equivalent volume of saline. OUTCOME MEASURES--Pain and tenderness scores, assessment of patient comfort, accuracy of diagnosis, and management decisions. RESULTS--Median pain and tenderness scores were lower after papaveretum (pain score 8.3 in control group and 3.1 in treatment group, p < 0.0001; tenderness score 8.1 in control group and 5.1 in treatment group, p < 0.0001). Forty eight patients were deemed to be comfortable after papaveretum compared with nine after saline. Incorrect diagnoses and management decisions applied to two patients after papaveretum compared with nine patients after saline. CONCLUSION--Early administration of opiate analgesia to patients with acute abdominal pain can greatly reduce their pain. This does not interfere with diagnosis, which may even be facilitated despite a reduction in the severity of physical signs. These patients should not be denied effective treatment.     

Simplified computer-aided diagnosis of acute abdominal pain.

A simplified version of a system for computer-aided diagnosis of acute abdominal pain has been tested by "new" personnel unfamiliar with the previous system. After a two-month learning period the system proved more accurate in its diagnoses than the unaided clinician, and during the first five months of using the system the unaided clinicians'' accuracy rose from 73% to 84%. When computer "feedback" was withdrawn the clinicians'' diagnostic accuracy reverted towards the previous, "unaided" level. These findings further validate the concept of the computer as a potentially valuable diagnostic aid but indicate that a training period and computer feedback are important factors in its 4 use.