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TOPLINE:

A retrospective cohort study found that older adults visiting the emergency department (ED) with abdominal pain underwent CT imaging more often than younger adults and were more likely to have acute, actionable CT findings. However, older adults with serious conditions were less likely to exhibit clear abdominal tenderness, making diagnosis more difficult.

METHODOLOGY:

• Researchers conducted a retrospective cohort analysis of data from 1169 ED visits for nontraumatic abdominal pain at a community teaching hospital in Baltimore between 2016 and 2017, including 547 younger adults (aged 18-39 years), 393 middle-aged adults (aged 40-59 years), and 229 older adults (aged 60 years or older).
• The researchers evaluated CT use, acute actionable CT findings, hospital admissions, surgeries, and a composite of adverse outcomes (including any actionable CT findings, emergency general surgical diagnoses, hospital admissions, or surgeries).
• The diagnostic performance of history and physical examination findings was evaluated using sensitivity and specificity analyses, and diagnostic diversity was assessed using the Herfindahl-Hirschman Index.

TAKEAWAY:

• CT ordering increased significantly with age. Across adults aged 18-39 years, 40-59 years, and 60 years or older, the rates of CT ordering were 41.7%, 66.2%, and 70.7%, respectively (P < .001). The rates of having acute, actionable (positive) CT findings also increased with age (18.4%, 31.2%, and 37.7% among adults aged 18-39 years, 40-59 years, and 60 years or older, respectively; P < .001).
• Older age was linked to increased rates of hospital admission (12.1%, 28.0%, and 37.6% among adults aged 18-39 years, 40-59 years, and 60 years or older, respectively; P < .001), surgical intervention (4.6%, 9.0%, and 10.6% among adults aged 18-39 years, 40-59 years, and 60 years or older, respectively; P = .002), and composite adverse outcomes (27.2%, 49.1%, and 57.6% among adults aged 18-39 years, 40-59 years, and 60 years or older, respectively; P < .001).
• Abdominal tenderness was less sensitive for identifying adverse outcomes in older adults (sensitivity, 0.58; 95% CI, 0.49-0.66) than in younger adults (0.73; 95% CI, 0.66-0.80), whereas rebound tenderness remained highly specific across all age groups (specificity, 0.96-0.98).
• The prediction of adverse outcomes improved with age (22% in adults aged 18-39 years, 25% in those aged 40-59 years, and 37% in those aged 60 years or older), whereas higher clinician suspicion was associated with a greater risk for adverse outcomes in older adults (P < .01).

IN PRACTICE:

"We found that while emergency clinicians account qualitatively for the increased risks and uncertainty of abdominal pain in older patients by increasing CT imaging, the yield of CT imaging is substantially higher in older adults. Additional testing would likely identify acute, intervenable findings," the authors wrote.

They added, "Informative signs and symptoms are less common in older adults despite higher rates of acute pathology, consistent with the geriatric hypothesis that older adults present with less specific symptoms." 

SOURCE:

The study was led by Ari B. Friedman, University of Pennsylvania, Philadelphia. It was published online on May 10, 2026, in Academic Emergency Medicine.

LIMITATIONS:

The study was conducted at a single urban community hospital, possibly limiting the generalizability of the findings. The sample size of adults aged 60 years or older was relatively small. Data were collected over a single 10-month period prior to the COVID pandemic, potentially limiting applicability to current practice. Outcomes such as ED revisits, 30-day mortality, and missed diagnoses among patients with negative CT findings could not be assessed. Important laboratory markers such as lactic acid and hepatobiliary or pancreatic laboratory parameters were not included in the original data abstraction, and CT modalities were not differentiated. In addition, only infected renal calculi were classified as adverse outcomes, excluding uncomplicated renal stones despite their potential symptom burden.

DISCLOSURES:

The study was funded by the National Institute on Aging. Several authors reported receiving research funding or support from academic, nonprofit, and healthcare organizations. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.