Karın Ağrısında Değerlendirme Yöntemleri ve Bedel Etkinlik
Özet
Karın ağrısı, acil başvuruların önemli bir bölümünü oluşturması ve gastroenteritten mezenter iskemiye, apandisitten rüptüre abdominal aort anevrizmasına kadar geniş ve potansiyel olarak ölümcül bir ayırıcı tanı spektrumu içermesi nedeniyle sistematik değerlendirme gerektirir. Klinik yaklaşımın temelini anamnez ve fizik muayene oluşturur. Anamnezde ağrının karakteri, başlangıcı, lokalizasyonu ve eşlik eden semptomların ayrıntılı sorgulanması; fizik muayenede ise vital bulgular, periton irritasyon bulguları ve ilgili sistem muayeneleri cerrahi aciliyetin erken belirlenmesinde kritik rol oynar. Laboratuvar testleri ayırıcı tanıda katkı sağlar; ancak tek başlarına cerrahi gereksinimi ayırt etmede sınırlıdır. Görüntüleme yöntemleri tanısal sürecin vazgeçilmez bileşenleridir. Ultrasonografi (USG), radyasyon içermemesi, yatak başında uygulanabilmesi nedeniyle ilk basamak yöntemdir. Bilgisayarlı tomografi (BT) özellikle nonspesifik akut karın ağrısı ve cerrahi şüpheli olgularda yüksek tanısal doğruluk sağlar; ancak gereksiz kullanımı maliyet artışı ve gereksiz radyasyon maruziyetine yol açar. Manyetik rezonans görüntüleme (MRG), ise radyasyondan kaçınılması gereken gruplarda alternatif bir seçenek olarak yer alır. Seri muayene ve gözlem stratejileri, uygun triyaj ve kılavuz temelli görüntüleme algoritmaları klinik güvenliği artırırken gereksiz tetkik ve yatışları azaltır. Mediko-legal açıdan doğru klinik kayıt ve kanıta dayalı yaklaşım büyük önem taşır. Sonuç olarak, acil serviste karın ağrısına yaklaşımda amaçlanan hedefin daha az tetkik değil, doğru hastada doğru zamanda ve kanıta dayalı biçimde seçilmiş tetkiklerin kullanılması olduğunu; böylece hızlı, güvenli ve bedel-etkin bir hasta yönetiminin mümkün olduğunu ortaya koymaktadır.
Abdominal pain constitutes a significant portion of emergency room visits and requires systematic evaluation due to its broad and potentially fatal differential diagnosis spectrum, ranging from gastroenteritis and mesenteric ischemia to appendicitis and ruptured abdominal aortic aneurysm. The clinical approach is based on history taking and physical examination. Detailed questioning of the character, onset, localization, and accompanying symptoms of the pain in the history taking process; and vital signs, signs of peritoneal irritation, and examination of relevant systems in the physical examination play a critical role in the early determination of surgical urgency. Laboratory tests contribute to the differential diagnosis; however, they are limited in their ability to distinguish the need for surgery on their own. Imaging methods are indispensable components of the diagnostic process. Ultrasonography (USG) is the first-line method due to its radiation-free nature and bedside application. Computed tomography (CT) provides high diagnostic accuracy, especially in cases of non-specific acute abdominal pain and suspected surgical intervention; however, unnecessary use leads to increased costs and unnecessary radiation exposure. Magnetic resonance imaging (MRI) is an alternative option in groups where radiation should be avoided. Serial examination and observation strategies, appropriate triage, and guideline-based imaging algorithms enhance clinical safety while reducing unnecessary investigations and hospitalizations. Accurate clinical records and an evidence-based approach are of paramount importance from a medico-legal perspective. In conclusion, the goal in approaching abdominal pain in the emergency department is not fewer investigations, but rather the use of appropriately selected investigations in the right patient at the right time, based on evidence; thus enabling rapid, safe, and cost-effective patient management.
Referanslar
Hastings, R., & Powers, R., 2011. Acil serviste karın ağrısı: 35 yıllık retrospektif. Amerikan Acil Tıp Dergisi, 29 7, ss. 711-6. https://doi.org/10.1016/j.ajem.2010.01.045 .
Osterwalder, I., Özkan, M., Malinovska, A., et al., 2020. Akut Karın Ağrısı: Kaçırılan Tanılar, Karın Dışı Durumlar ve Sonuçlar. Klinik Tıp Dergisi, 9. https://doi.org/10.3390/jcm9040899 .
Michael, M., Kleophas, A., Keitel, V., et al., 2021. [Acil Serviste Akut Karın Ağrısı].. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 56 6, s. 448-458. https://doi.org/10.1055/a-1191-1374 .
Halsey-Nichols, M., & McCoin, N., 2021. Abdominal Pain in the Emergency Department: Missed Diagnoses.. Emergency medicine clinics of North America, 39 4, pp. 703-717. https://doi.org/10.1016/j.emc.2021.07.005.
Macaluso, C., & McNamara, R., 2012. Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine, 5, pp. 789- 797. https://doi.org/10.2147/ijgm.s25936.
Wolfe, C., Halsey-Nichols, M., Ritter, K., et al., 2022. Acil Serviste Karın Ağrısı: Tanı İçin Doğru Görüntüleme Yönteminin Seçimi. Açık Erişimli Acil Tıp: OAEM, 14, ss. 335- 345. https://doi.org/10.2147/oaem.s342724 .
Wu, R., Adjei-Poku, M., Kelz, R., et al., 2024. Amerika Birleşik Devletleri'nde 2007-2019 yılları arasında acil servislerde karın ağrısı şikayetleriyle ilgili ziyaret, görüntüleme ve tanı eğilimleri. Akademik Acil Tıp , 32, ss. 20- 31. https://doi.org/10.1111/acem.15017 .
April, M., & Murray, B., 2017. Cost‐effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective. Academic Emergency Medicine, 24, pp. 754–768. https://doi.org/10.1111/acem.13186.
Lentz, B., Fong, T., Rhyne, R., et al., 2021. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. The Ultrasound Journal, 13. https://doi.org/10.1186/s13089-021-00216-8.
Delaney, P., Offorjebe, O., & Arudo, J., 2024. Financing and cost-effectiveness of emergency medical services in low- and middle-income countries.. Surgery. https://doi.org/10.1016/j.surg.2024.06.032.
Werner, K., Risko, N., Burkholder, T., et al., 2020. Cost–effectiveness of emergency care interventions in low and middle-income countries: a systematic review. Bulletin of the World Health Organization, 98, pp. 341 - 352. https://doi.org/10.2471/blt.19.241158.
Börner, N., Kappenberger, A., Weber, S., et al., 2025. The Acute Abdomen: Structured Diagnosis and Treatment.. Deutsches Arzteblatt international, Forthcoming. https://doi.org/10.3238/arztebl.m2025.0019.
Karakuş, A., Kaya, E., & Kuvandik, G., 2018. Management to the abdominal pain in emergency department. The Journal of Turkish Family Physician. https://doi.org/10.15511/tjtfp.18.00259.
Gans, S., Pols, M., Stoker, J., et al., 2015. Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain. Digestive Surgery, 32, pp. 23 - 31. https://doi.org/10.1159/000371583.
Joksimović, Z., & Bastać, D., 2022. Anamnesis: The skill and art of clinical medicine. Timocki medicinski glasnik. https://doi.org/10.5937/tmg2204153j.
De Almeida, C., & Gotardo, D., 2022. Introduction to semiology: construction of clinical history. Reflections of a digital extension course. International Journal of Education and Health. https://doi.org/10.17267/2594-7907ijeh.2022.e3745.
Sabo, C., Grad, S., & Dumitrascu, D., 2021. Chronic Abdominal Pain in General Practice. Digestive Diseases, 39, pp. 606 - 614. https://doi.org/10.1159/000515433.
Apau, D., 2010. Assessing abdominal pain through history taking and physical examination. Gastrointestinal Nursing, 8, pp. 50-53. https://doi.org/10.12968/gasn.2010.8.7.78435.
Peart, P., 2022. History and clinical examination of an adult abdomen. Clinics in Integrated Care. https://doi.org/10.1016/j.intcar.2022.100113.
Alattar, Z., & Keric, N., 2023. Evaluation of Abdominal Emergencies.. The Surgical clinics of North America, 103 6, pp. 1043-1059 . https://doi.org/10.1016/j.suc.2023.05.010.
Cartwright, S., & Knudson, M., 2008. Evaluation of acute abdominal pain in adults.. American family physician, 77 7, pp. 971-8 .
Bhattacharjee, P., 2023. Abdominal examination: Invaluable clinical findings and their interpretations. IP Journal of Surgery and Allied Sciences. https://doi.org/10.18231/j.jsas.2022.024.
Fernández, J., López, P., Montes, J., et al., 2009. Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department.. Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva, 101 9, pp. 610-8. https://doi.org/10.4321/s1130-01082009000900003.
Kiani, F., Yazd, S., Zarimeidani, F., et al. 2025. Diagnostic Value of Physical Examination, Ultrasound, and Radiography Compared to Computed Tomography in the Evaluation of Nontraumatic Left Lower Quadrant Acute Abdominal Pain. Emergency Medicine International, 2025. https://doi.org/10.1155/emmi/1681801.
Velissaris, D., Karanikolas, M., Pantzaris, N., et al., 2017. Acute Abdominal Pain Assessment in the Emergency Department: The Experience of a Greek University Hospital. Journal of Clinical Medicine Research, 9, pp. 987- 993. https://doi.org/10.14740/jocmr3206w.
Parfenov, A., 2023. [Abdominal pain].. Terapevticheskii arkhiv, 95 2, pp. 113-119. https://doi.org/10.26442/00403660.2023.02.202055.
Özgüç, H., Çakın, N., & Duman, U., 2008. Akut nonspesifik karın ağrılı olguların bir yıllık prognozları, semptom ve bulgularının tanısal doğruluğu. Turkish journal of trauma & emergency surgery, 14, pp. 118-124.
Çatal, Y., Kır, N., Genç, S., et al., 2024. Effectiveness of laboratory tests in predicting pathologies on computed tomography in geriatric patients with abdominal pain. Cukurova Medical Journal. https://doi.org/10.17826/cumj.1414439.
Smereck, J., 2019. Is Laboratory Data Helpful in the Workup of Chronic Abdominal Pain?. Gastrointestinal Emergencies. https://doi.org/10.1007/978-3-319-98343-1_140.
Cymbal, M., Chatterjee, A., Ajayi-Fox, P., et al., 2025. Specialty laboratory testing for chronic abdominal pain in irritable bowel syndrome. Scandinavian Journal of Gastroenterology, 60, pp. 248- 252. https://doi.org/10.1080/00365521.2025.2456491.
Bauer, I., Grossmann, K., Risch, L., et al., 2024. B-125 Laboratory Profiles for Diagnostic Workup of Acute Abdominal Pain in the Emergency Department: A Comparative Study of University and Non-University Acute Care Hospitals in Germany and Switzerland. Clinical Chemistry. https://doi.org/10.1093/clinchem/hvae106.486.
Gröning, I., Friebe, M., Fundel, B., et al., 2023. Die Bedeutung von Laborleistungen bei der klinischen Notfallbehandlung in Notaufnahmen beim Leitsymptom „akuter Bauchschmerz“. Notfall + Rettungsmedizin, 27, pp. 266 - 272. https://doi.org/10.1007/s10049-023-01176-3.
Farmer, R., 2015. Costs and stewardship of laboratory tests in the Capital Health District. Dalhousie Medical Journal, 42. https://doi.org/10.15273/dmj.vol42no1.6431.
Goldstein, L., Wells, M., & Vincent-Lambert, C., 2019. The cost of time: A randomised, controlled trial to assess the economic impact of upfront, point-of-care blood tests in the Emergency Centre. African Journal of Emergency Medicine, 9, pp. 57- 63. https://doi.org/10.1016/j.afjem.2019.01.011.
Stoker, J., Van Randen, A., Laméris, W., et al., 2009. Imaging patients with acute abdominal pain. Radiology, 253 1, pp. 31-46 . https://doi.org/10.1148/radiol.2531090302.
Cartwright, S., & Knudson, M., 2015. Diagnostic imaging of acute abdominal pain in adults. American family physician, 91 7, pp. 452-9.
Yew, K., George, M., & Allred, H., 2023. Acute Abdominal Pain in Adults: Evaluation and Diagnosis.. American family physician, 107 6, pp. 585-596.
Scheirey, C., Fowler, K., Therrien, J., et al., 2018. ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain.. Journal of the American College of Radiology: JACR, 15 11S, pp. S217-S231. https://doi.org/10.1016/j.jacr.2018.09.010.
Gans, S., Stoker, J., & Boermeester, M., 2012. Plain abdominal radiography in acute abdominal pain; past, present, and future. International Journal of General Medicine, 5, pp. 525- 533. https://doi.org/10.2147/ijgm.s17410.
Zeina, A., Shapira-Rootman, M., Mahamid, A., et al., 2015. Role of Plain Abdominal Radiographs in the Evaluation of Patients with Non-Traumatic Abdominal Pain.. The Israel Medical Association journal: IMAJ, 17 11, pp. 678-81.
Prasannan, S., Zhueng, T., & Gul, Y., 2005. Diagnostic value of plain abdominal radiographs in patients with acute abdominal pain.. Asian journal of surgery, 28 4, pp. 246-51. https://doi.org/10.1016/s1015-9584(09)60354-7.
Ahmed, R., Suliman, H., Jan, B., et al., 2025. Critical Appraisal of Plain Abdominal X-rays in Acute Abdomen: A Review. Cureus, 17. https://doi.org/10.7759/cureus.80420.
Sreedharan, S., Fiorentino, M., & Sinha, S., 2014. Plain abdominal radiography in acute abdominal pain—is it really necessary?. Emergency Radiology, 21, pp. 597-603. https://doi.org/10.1007/s10140-014-1244-y.
Denham, G., Smith, T., James, D., et al., 2020. Exploring the evidence-practice gap in the use of plain radiography for acute abdominal pain and intestinal obstruction: a systematic review and meta-analysis.. International Journal of Evidence-Based Healthcare. https://doi.org/10.1097/xeb.0000000000000218.
Armstrong, L., Monaghan, H., & Jeffers, S., 2021. SP9.1.3 Abdominal X-Rays in the Emergency Setting- A Review of Current Practice. British Journal of Surgery. https://doi.org/10.1093/bjs/znab361.167.
Garcia, G., Del Campo Del Val, L., Béliz, S., et al., 2024. Utilization of abdominal radiography in the emergency department: Appropriateness, interpretation, radiation protection and costs.. Radiologia, 66 4, pp. 307-313. https://doi.org/10.1016/j.rxeng.2023.01.012.
Boccatonda, A., D’Ardes, D., Tallarico, V., et al., 2023. Gastrointestinal Ultrasound in Emergency Setting. Journal of Clinical Medicine, 12. https://doi.org/10.3390/jcm12030799.
Mazzei, M., Guerrini, S., Squitieri, C., et al., 2013. The role of US examination in the management of acute abdomen. Critical Ultrasound Journal, 5, pp. S6- S6. https://doi.org/10.1186/2036-7902-5-s1-s6.
Perysinakis, I., & Vassalou, E., 2024. Non-traumatic lower abdominal pain: ultrasonographic and clinical differential diagnosis. Ultrasonography, 43, pp. 151- 168. https://doi.org/10.14366/usg.23227.
Marasco, G., Verardi, F., Eusebi, L., et al., 2019. Diagnostic imaging for acute abdominal pain in an Emergency Department in Italy. Internal and Emergency Medicine, 14, pp. 1147- 1153. https://doi.org/10.1007/s11739-019-02189-y.
Albishare, E., Bushaala, N., Radwan, M., et al., 2025. The Diagnostic Value of Abdominal Ultrasound in Children with Acute Abdominal Pain. SAS Journal of Medicine. https://doi.org/10.36347/sasjm.2025.v11i03.017.
Tomizawa, M., Shinozaki, F., Hasegawa, R., et al., 2017. Abdominal ultrasonography for patients with abdominal pain as a first-line diagnostic imaging modality.. Experimental and therapeutic medicine, 13 5, pp. 1932-1936. https://doi.org/10.3892/etm.2017.4209.
Cortellaro, F., Perani, C., Guarnieri, L., et al., 2019. Point-of-Care Ultrasound in the Diagnosis of Acute Abdominal Pain. Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. https://doi.org/10.1007/978-3-319-95114-0_27.
Kameda, T., & Taniguchi, N., 2016. Overview of point-of-care abdominal ultrasound in emergency and critical care. Journal of Intensive Care, 4. https://doi.org/10.1186/s40560-016-0175-y.
Cristina, B., Chiara, G., Benedetta, D., et al., 2019. Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department. Mediterranean Journal of Emergency Medicine & Acute Care. https://doi.org/10.52544/2642-7184(1)1001.
Ghosh, S., & Naskar, S., 2020. Role of USG in patients with acute abdomen in a tertiary care centre in West Bengal. International journal of scientific research, 9.
Harskamp, R., Keute, S., Pleiter, C., et al., 2025. Ultrasonography in General Practice: insights from an implementation study in a Low-income neighborhood of Amsterdam.. https://doi.org/10.1101/2025.05.22.25327578.
Strömberg, C., Johansson, G., & Adolfsson, A., 2007. Acute Abdominal Pain: Diagnostic Impact of Immediate CT Scanning. World Journal of Surgery, 31, pp. 2347-2354. https://doi.org/10.1007/s00268-007-9233-x.
Lehtimäki, T., Juvonen, P., Valtonen, H., et al., 2013. Impact of routine contrast-enhanced CT on costs and use of hospital resources in patients with acute abdomen. Results of a randomised clinical trial. European Radiology, 23, pp. 2538-2545. https://doi.org/10.1007/s00330-013-2848-4.
Lehtimäki, T., Valtonen, H., Miettinen, P., et al., 2017. A randomised clinical trial of routine versus selective CT imaging in acute abdomen: Impact of patient age on treatment costs and hospital resource use.. European journal of radiology, 87, pp. 1-7. https://doi.org/10.1016/j.ejrad.2016.11.031.
Romero, J., Sanabria, Á., Angarita, M., et al., 2008. Cost-effectiveness of computed tomography and ultrasound in the diagnosis of appendicitis.. Biomedica: revista del Instituto Nacional de Salud, 28 1, pp. 139-47. https://doi.org/10.7705/biomedica.v28i1.116.
Guo, H., Jia, Y., Li, H., et al., 2025. Impact of CT turnaround time on diagnostic and clinical outcomes in acute abdominal pain: A retrospective cohort study.. The American journal of emergency medicine, 99, pp. 9-16 . https://doi.org/10.1016/j.ajem.2025.09.011.
Charret, O., Fournier, L., Poncelet, E., et al., 2025. MRI as an alternative to CT after inconclusive ultrasound in subacute/acute abdominal pain in young women: a prospective multicenter noninferiority study. European Radiology, 35, pp. 6642- 6654. https://doi.org/10.1007/s00330-025-11629-7.
Bidani, K., Singh, R., Chandra, G., et al., 2022. Magnetic Resonance Imaging in Gastrointestinal and Genitourinary Emergencies.. Magnetic resonance imaging clinics of North America, 30 3, pp. 501-513. https://doi.org/10.1016/j.mric.2022.03.005.
Inoue, A., Furukawa, A., Takaki, K., et al., 2020. Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation. Japanese Journal of Radiology, 39, pp. 209- 224. https://doi.org/10.1007/s11604-020-01053-w.
Dempsey, P., Delaney, F., Geoghegan, T., et al., 2022. MR imaging of acute abdominal pain in pregnancy.. The British journal of radiology, pp. 20211114. https://doi.org/10.1259/bjr.20211114.
Hagedorn, K., Hayatghaibi, S., Levine, M., et al., 2019. Cost Comparison of Ultrasound Versus MRI to Diagnose Adolescent Female Patients Presenting with Acute Abdominal/Pelvic Pain Using Time-Driven Activity-Based Costing.. Academic radiology. https://doi.org/10.1016/j.acra.2019.03.023.
Yu, H., Rosman, D., Likhari, G., et al., 2021. The clinical utility of inpatient MRI following an abdominopelvic CT. Abdominal Radiology, 46, pp. 5443- 5448. https://doi.org/10.1007/s00261-021-03237-y.
Gray, A., Clarke, P., Wolstenholme, J., et al., 2010. Applied Methods of Cost-Effectiveness Analysis in Healthcare. .
Gold, M., 2016. Cost-effectiveness in health and medicine. . https://doi.org/10.1093/acprof:oso/9780190492939.001.0001.
Turner, H., Archer, R., Downey, L., et al., 2021. An Introduction to the Main Types of Economic Evaluations Used for Informing Priority Setting and Resource Allocation in Healthcare: Key Features, Uses, and Limitations. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.722927.
Colucciello, S., 2019. Assessing abdominal pain in adults: a rational, cost-effective, and evidence-based strategy.. Emergency medicine practice, 21 6, pp. 1-32.
Kuo, R., Song, P., Nguyen, T., et al., 2023. An application of multi-objective simulation optimization to medical resource allocation for the emergency department in Taiwan. Annals of Operations Research, 326, pp. 199- 221. https://doi.org/10.1007/s10479-023-05374-7.
Gorji, H., Moeini, S., Sheikhrobat, M., et al., 2025. Economic Evaluation of Acute Appendicitis Therapeutic Interventions: A Systematic Review. Health Science Reports, 8. https://doi.org/10.1002/hsr2.70815.
Novak, K., Qureshi, A., Carter, J., et al., 2024. Management of nonurgent common gastroenterology referrals using primary care clinical pathways. Canadian Family Physician Médecin de famille canadien, 70, pp. e197 - e206. https://doi.org/10.46747/cfp.701112e197.
Silva, H., Oliveira, F., Prado, L., et al., 2019. Tomografia Computadorizada de Abdome na Urgência: o Uso Exagerado das Tecnologias Médicas e a Desvalorização do Diagnóstico Clínico. Revista Brasileira de Educação Médica. https://doi.org/10.1590/1981-5271v43suplemento1-20190022.
Covertier, V., Patterson, B., & Zayas-Cabán, G., 2022. Association between advanced image ordered in the emergency department on subsequent imaging for abdominal pain patients. Academic Emergency Medicine, 29, pp. 1078- 1083. https://doi.org/10.1111/acem.14541.
Kendle, A., & Kaide, C., 2024. Abdominal Pain-Specific Legal Risk.. Emergency medicine clinics of North America, 1, pp. 93-113. https://doi.org/10.1016/j.emc.2024.05.027.
Habek, D., & Šklebar, I., 2019. Medico-Legal responsibility in management of acute and chronic pain in obstetric. Acta Clinica Croatica, 58, pp. 114- 117. https://doi.org/10.20471/acc.2019.58.s1.17.
Referanslar
Hastings, R., & Powers, R., 2011. Acil serviste karın ağrısı: 35 yıllık retrospektif. Amerikan Acil Tıp Dergisi, 29 7, ss. 711-6. https://doi.org/10.1016/j.ajem.2010.01.045 .
Osterwalder, I., Özkan, M., Malinovska, A., et al., 2020. Akut Karın Ağrısı: Kaçırılan Tanılar, Karın Dışı Durumlar ve Sonuçlar. Klinik Tıp Dergisi, 9. https://doi.org/10.3390/jcm9040899 .
Michael, M., Kleophas, A., Keitel, V., et al., 2021. [Acil Serviste Akut Karın Ağrısı].. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 56 6, s. 448-458. https://doi.org/10.1055/a-1191-1374 .
Halsey-Nichols, M., & McCoin, N., 2021. Abdominal Pain in the Emergency Department: Missed Diagnoses.. Emergency medicine clinics of North America, 39 4, pp. 703-717. https://doi.org/10.1016/j.emc.2021.07.005.
Macaluso, C., & McNamara, R., 2012. Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine, 5, pp. 789- 797. https://doi.org/10.2147/ijgm.s25936.
Wolfe, C., Halsey-Nichols, M., Ritter, K., et al., 2022. Acil Serviste Karın Ağrısı: Tanı İçin Doğru Görüntüleme Yönteminin Seçimi. Açık Erişimli Acil Tıp: OAEM, 14, ss. 335- 345. https://doi.org/10.2147/oaem.s342724 .
Wu, R., Adjei-Poku, M., Kelz, R., et al., 2024. Amerika Birleşik Devletleri'nde 2007-2019 yılları arasında acil servislerde karın ağrısı şikayetleriyle ilgili ziyaret, görüntüleme ve tanı eğilimleri. Akademik Acil Tıp , 32, ss. 20- 31. https://doi.org/10.1111/acem.15017 .
April, M., & Murray, B., 2017. Cost‐effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective. Academic Emergency Medicine, 24, pp. 754–768. https://doi.org/10.1111/acem.13186.
Lentz, B., Fong, T., Rhyne, R., et al., 2021. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. The Ultrasound Journal, 13. https://doi.org/10.1186/s13089-021-00216-8.
Delaney, P., Offorjebe, O., & Arudo, J., 2024. Financing and cost-effectiveness of emergency medical services in low- and middle-income countries.. Surgery. https://doi.org/10.1016/j.surg.2024.06.032.
Werner, K., Risko, N., Burkholder, T., et al., 2020. Cost–effectiveness of emergency care interventions in low and middle-income countries: a systematic review. Bulletin of the World Health Organization, 98, pp. 341 - 352. https://doi.org/10.2471/blt.19.241158.
Börner, N., Kappenberger, A., Weber, S., et al., 2025. The Acute Abdomen: Structured Diagnosis and Treatment.. Deutsches Arzteblatt international, Forthcoming. https://doi.org/10.3238/arztebl.m2025.0019.
Karakuş, A., Kaya, E., & Kuvandik, G., 2018. Management to the abdominal pain in emergency department. The Journal of Turkish Family Physician. https://doi.org/10.15511/tjtfp.18.00259.
Gans, S., Pols, M., Stoker, J., et al., 2015. Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain. Digestive Surgery, 32, pp. 23 - 31. https://doi.org/10.1159/000371583.
Joksimović, Z., & Bastać, D., 2022. Anamnesis: The skill and art of clinical medicine. Timocki medicinski glasnik. https://doi.org/10.5937/tmg2204153j.
De Almeida, C., & Gotardo, D., 2022. Introduction to semiology: construction of clinical history. Reflections of a digital extension course. International Journal of Education and Health. https://doi.org/10.17267/2594-7907ijeh.2022.e3745.
Sabo, C., Grad, S., & Dumitrascu, D., 2021. Chronic Abdominal Pain in General Practice. Digestive Diseases, 39, pp. 606 - 614. https://doi.org/10.1159/000515433.
Apau, D., 2010. Assessing abdominal pain through history taking and physical examination. Gastrointestinal Nursing, 8, pp. 50-53. https://doi.org/10.12968/gasn.2010.8.7.78435.
Peart, P., 2022. History and clinical examination of an adult abdomen. Clinics in Integrated Care. https://doi.org/10.1016/j.intcar.2022.100113.
Alattar, Z., & Keric, N., 2023. Evaluation of Abdominal Emergencies.. The Surgical clinics of North America, 103 6, pp. 1043-1059 . https://doi.org/10.1016/j.suc.2023.05.010.
Cartwright, S., & Knudson, M., 2008. Evaluation of acute abdominal pain in adults.. American family physician, 77 7, pp. 971-8 .
Bhattacharjee, P., 2023. Abdominal examination: Invaluable clinical findings and their interpretations. IP Journal of Surgery and Allied Sciences. https://doi.org/10.18231/j.jsas.2022.024.
Fernández, J., López, P., Montes, J., et al., 2009. Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department.. Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva, 101 9, pp. 610-8. https://doi.org/10.4321/s1130-01082009000900003.
Kiani, F., Yazd, S., Zarimeidani, F., et al. 2025. Diagnostic Value of Physical Examination, Ultrasound, and Radiography Compared to Computed Tomography in the Evaluation of Nontraumatic Left Lower Quadrant Acute Abdominal Pain. Emergency Medicine International, 2025. https://doi.org/10.1155/emmi/1681801.
Velissaris, D., Karanikolas, M., Pantzaris, N., et al., 2017. Acute Abdominal Pain Assessment in the Emergency Department: The Experience of a Greek University Hospital. Journal of Clinical Medicine Research, 9, pp. 987- 993. https://doi.org/10.14740/jocmr3206w.
Parfenov, A., 2023. [Abdominal pain].. Terapevticheskii arkhiv, 95 2, pp. 113-119. https://doi.org/10.26442/00403660.2023.02.202055.
Özgüç, H., Çakın, N., & Duman, U., 2008. Akut nonspesifik karın ağrılı olguların bir yıllık prognozları, semptom ve bulgularının tanısal doğruluğu. Turkish journal of trauma & emergency surgery, 14, pp. 118-124.
Çatal, Y., Kır, N., Genç, S., et al., 2024. Effectiveness of laboratory tests in predicting pathologies on computed tomography in geriatric patients with abdominal pain. Cukurova Medical Journal. https://doi.org/10.17826/cumj.1414439.
Smereck, J., 2019. Is Laboratory Data Helpful in the Workup of Chronic Abdominal Pain?. Gastrointestinal Emergencies. https://doi.org/10.1007/978-3-319-98343-1_140.
Cymbal, M., Chatterjee, A., Ajayi-Fox, P., et al., 2025. Specialty laboratory testing for chronic abdominal pain in irritable bowel syndrome. Scandinavian Journal of Gastroenterology, 60, pp. 248- 252. https://doi.org/10.1080/00365521.2025.2456491.
Bauer, I., Grossmann, K., Risch, L., et al., 2024. B-125 Laboratory Profiles for Diagnostic Workup of Acute Abdominal Pain in the Emergency Department: A Comparative Study of University and Non-University Acute Care Hospitals in Germany and Switzerland. Clinical Chemistry. https://doi.org/10.1093/clinchem/hvae106.486.
Gröning, I., Friebe, M., Fundel, B., et al., 2023. Die Bedeutung von Laborleistungen bei der klinischen Notfallbehandlung in Notaufnahmen beim Leitsymptom „akuter Bauchschmerz“. Notfall + Rettungsmedizin, 27, pp. 266 - 272. https://doi.org/10.1007/s10049-023-01176-3.
Farmer, R., 2015. Costs and stewardship of laboratory tests in the Capital Health District. Dalhousie Medical Journal, 42. https://doi.org/10.15273/dmj.vol42no1.6431.
Goldstein, L., Wells, M., & Vincent-Lambert, C., 2019. The cost of time: A randomised, controlled trial to assess the economic impact of upfront, point-of-care blood tests in the Emergency Centre. African Journal of Emergency Medicine, 9, pp. 57- 63. https://doi.org/10.1016/j.afjem.2019.01.011.
Stoker, J., Van Randen, A., Laméris, W., et al., 2009. Imaging patients with acute abdominal pain. Radiology, 253 1, pp. 31-46 . https://doi.org/10.1148/radiol.2531090302.
Cartwright, S., & Knudson, M., 2015. Diagnostic imaging of acute abdominal pain in adults. American family physician, 91 7, pp. 452-9.
Yew, K., George, M., & Allred, H., 2023. Acute Abdominal Pain in Adults: Evaluation and Diagnosis.. American family physician, 107 6, pp. 585-596.
Scheirey, C., Fowler, K., Therrien, J., et al., 2018. ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain.. Journal of the American College of Radiology: JACR, 15 11S, pp. S217-S231. https://doi.org/10.1016/j.jacr.2018.09.010.
Gans, S., Stoker, J., & Boermeester, M., 2012. Plain abdominal radiography in acute abdominal pain; past, present, and future. International Journal of General Medicine, 5, pp. 525- 533. https://doi.org/10.2147/ijgm.s17410.
Zeina, A., Shapira-Rootman, M., Mahamid, A., et al., 2015. Role of Plain Abdominal Radiographs in the Evaluation of Patients with Non-Traumatic Abdominal Pain.. The Israel Medical Association journal: IMAJ, 17 11, pp. 678-81.
Prasannan, S., Zhueng, T., & Gul, Y., 2005. Diagnostic value of plain abdominal radiographs in patients with acute abdominal pain.. Asian journal of surgery, 28 4, pp. 246-51. https://doi.org/10.1016/s1015-9584(09)60354-7.
Ahmed, R., Suliman, H., Jan, B., et al., 2025. Critical Appraisal of Plain Abdominal X-rays in Acute Abdomen: A Review. Cureus, 17. https://doi.org/10.7759/cureus.80420.
Sreedharan, S., Fiorentino, M., & Sinha, S., 2014. Plain abdominal radiography in acute abdominal pain—is it really necessary?. Emergency Radiology, 21, pp. 597-603. https://doi.org/10.1007/s10140-014-1244-y.
Denham, G., Smith, T., James, D., et al., 2020. Exploring the evidence-practice gap in the use of plain radiography for acute abdominal pain and intestinal obstruction: a systematic review and meta-analysis.. International Journal of Evidence-Based Healthcare. https://doi.org/10.1097/xeb.0000000000000218.
Armstrong, L., Monaghan, H., & Jeffers, S., 2021. SP9.1.3 Abdominal X-Rays in the Emergency Setting- A Review of Current Practice. British Journal of Surgery. https://doi.org/10.1093/bjs/znab361.167.
Garcia, G., Del Campo Del Val, L., Béliz, S., et al., 2024. Utilization of abdominal radiography in the emergency department: Appropriateness, interpretation, radiation protection and costs.. Radiologia, 66 4, pp. 307-313. https://doi.org/10.1016/j.rxeng.2023.01.012.
Boccatonda, A., D’Ardes, D., Tallarico, V., et al., 2023. Gastrointestinal Ultrasound in Emergency Setting. Journal of Clinical Medicine, 12. https://doi.org/10.3390/jcm12030799.
Mazzei, M., Guerrini, S., Squitieri, C., et al., 2013. The role of US examination in the management of acute abdomen. Critical Ultrasound Journal, 5, pp. S6- S6. https://doi.org/10.1186/2036-7902-5-s1-s6.
Perysinakis, I., & Vassalou, E., 2024. Non-traumatic lower abdominal pain: ultrasonographic and clinical differential diagnosis. Ultrasonography, 43, pp. 151- 168. https://doi.org/10.14366/usg.23227.
Marasco, G., Verardi, F., Eusebi, L., et al., 2019. Diagnostic imaging for acute abdominal pain in an Emergency Department in Italy. Internal and Emergency Medicine, 14, pp. 1147- 1153. https://doi.org/10.1007/s11739-019-02189-y.
Albishare, E., Bushaala, N., Radwan, M., et al., 2025. The Diagnostic Value of Abdominal Ultrasound in Children with Acute Abdominal Pain. SAS Journal of Medicine. https://doi.org/10.36347/sasjm.2025.v11i03.017.
Tomizawa, M., Shinozaki, F., Hasegawa, R., et al., 2017. Abdominal ultrasonography for patients with abdominal pain as a first-line diagnostic imaging modality.. Experimental and therapeutic medicine, 13 5, pp. 1932-1936. https://doi.org/10.3892/etm.2017.4209.
Cortellaro, F., Perani, C., Guarnieri, L., et al., 2019. Point-of-Care Ultrasound in the Diagnosis of Acute Abdominal Pain. Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. https://doi.org/10.1007/978-3-319-95114-0_27.
Kameda, T., & Taniguchi, N., 2016. Overview of point-of-care abdominal ultrasound in emergency and critical care. Journal of Intensive Care, 4. https://doi.org/10.1186/s40560-016-0175-y.
Cristina, B., Chiara, G., Benedetta, D., et al., 2019. Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department. Mediterranean Journal of Emergency Medicine & Acute Care. https://doi.org/10.52544/2642-7184(1)1001.
Ghosh, S., & Naskar, S., 2020. Role of USG in patients with acute abdomen in a tertiary care centre in West Bengal. International journal of scientific research, 9.
Harskamp, R., Keute, S., Pleiter, C., et al., 2025. Ultrasonography in General Practice: insights from an implementation study in a Low-income neighborhood of Amsterdam.. https://doi.org/10.1101/2025.05.22.25327578.
Strömberg, C., Johansson, G., & Adolfsson, A., 2007. Acute Abdominal Pain: Diagnostic Impact of Immediate CT Scanning. World Journal of Surgery, 31, pp. 2347-2354. https://doi.org/10.1007/s00268-007-9233-x.
Lehtimäki, T., Juvonen, P., Valtonen, H., et al., 2013. Impact of routine contrast-enhanced CT on costs and use of hospital resources in patients with acute abdomen. Results of a randomised clinical trial. European Radiology, 23, pp. 2538-2545. https://doi.org/10.1007/s00330-013-2848-4.
Lehtimäki, T., Valtonen, H., Miettinen, P., et al., 2017. A randomised clinical trial of routine versus selective CT imaging in acute abdomen: Impact of patient age on treatment costs and hospital resource use.. European journal of radiology, 87, pp. 1-7. https://doi.org/10.1016/j.ejrad.2016.11.031.
Romero, J., Sanabria, Á., Angarita, M., et al., 2008. Cost-effectiveness of computed tomography and ultrasound in the diagnosis of appendicitis.. Biomedica: revista del Instituto Nacional de Salud, 28 1, pp. 139-47. https://doi.org/10.7705/biomedica.v28i1.116.
Guo, H., Jia, Y., Li, H., et al., 2025. Impact of CT turnaround time on diagnostic and clinical outcomes in acute abdominal pain: A retrospective cohort study.. The American journal of emergency medicine, 99, pp. 9-16 . https://doi.org/10.1016/j.ajem.2025.09.011.
Charret, O., Fournier, L., Poncelet, E., et al., 2025. MRI as an alternative to CT after inconclusive ultrasound in subacute/acute abdominal pain in young women: a prospective multicenter noninferiority study. European Radiology, 35, pp. 6642- 6654. https://doi.org/10.1007/s00330-025-11629-7.
Bidani, K., Singh, R., Chandra, G., et al., 2022. Magnetic Resonance Imaging in Gastrointestinal and Genitourinary Emergencies.. Magnetic resonance imaging clinics of North America, 30 3, pp. 501-513. https://doi.org/10.1016/j.mric.2022.03.005.
Inoue, A., Furukawa, A., Takaki, K., et al., 2020. Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation. Japanese Journal of Radiology, 39, pp. 209- 224. https://doi.org/10.1007/s11604-020-01053-w.
Dempsey, P., Delaney, F., Geoghegan, T., et al., 2022. MR imaging of acute abdominal pain in pregnancy.. The British journal of radiology, pp. 20211114. https://doi.org/10.1259/bjr.20211114.
Hagedorn, K., Hayatghaibi, S., Levine, M., et al., 2019. Cost Comparison of Ultrasound Versus MRI to Diagnose Adolescent Female Patients Presenting with Acute Abdominal/Pelvic Pain Using Time-Driven Activity-Based Costing.. Academic radiology. https://doi.org/10.1016/j.acra.2019.03.023.
Yu, H., Rosman, D., Likhari, G., et al., 2021. The clinical utility of inpatient MRI following an abdominopelvic CT. Abdominal Radiology, 46, pp. 5443- 5448. https://doi.org/10.1007/s00261-021-03237-y.
Gray, A., Clarke, P., Wolstenholme, J., et al., 2010. Applied Methods of Cost-Effectiveness Analysis in Healthcare. .
Gold, M., 2016. Cost-effectiveness in health and medicine. . https://doi.org/10.1093/acprof:oso/9780190492939.001.0001.
Turner, H., Archer, R., Downey, L., et al., 2021. An Introduction to the Main Types of Economic Evaluations Used for Informing Priority Setting and Resource Allocation in Healthcare: Key Features, Uses, and Limitations. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.722927.
Colucciello, S., 2019. Assessing abdominal pain in adults: a rational, cost-effective, and evidence-based strategy.. Emergency medicine practice, 21 6, pp. 1-32.
Kuo, R., Song, P., Nguyen, T., et al., 2023. An application of multi-objective simulation optimization to medical resource allocation for the emergency department in Taiwan. Annals of Operations Research, 326, pp. 199- 221. https://doi.org/10.1007/s10479-023-05374-7.
Gorji, H., Moeini, S., Sheikhrobat, M., et al., 2025. Economic Evaluation of Acute Appendicitis Therapeutic Interventions: A Systematic Review. Health Science Reports, 8. https://doi.org/10.1002/hsr2.70815.
Novak, K., Qureshi, A., Carter, J., et al., 2024. Management of nonurgent common gastroenterology referrals using primary care clinical pathways. Canadian Family Physician Médecin de famille canadien, 70, pp. e197 - e206. https://doi.org/10.46747/cfp.701112e197.
Silva, H., Oliveira, F., Prado, L., et al., 2019. Tomografia Computadorizada de Abdome na Urgência: o Uso Exagerado das Tecnologias Médicas e a Desvalorização do Diagnóstico Clínico. Revista Brasileira de Educação Médica. https://doi.org/10.1590/1981-5271v43suplemento1-20190022.
Covertier, V., Patterson, B., & Zayas-Cabán, G., 2022. Association between advanced image ordered in the emergency department on subsequent imaging for abdominal pain patients. Academic Emergency Medicine, 29, pp. 1078- 1083. https://doi.org/10.1111/acem.14541.
Kendle, A., & Kaide, C., 2024. Abdominal Pain-Specific Legal Risk.. Emergency medicine clinics of North America, 1, pp. 93-113. https://doi.org/10.1016/j.emc.2024.05.027.
Habek, D., & Šklebar, I., 2019. Medico-Legal responsibility in management of acute and chronic pain in obstetric. Acta Clinica Croatica, 58, pp. 114- 117. https://doi.org/10.20471/acc.2019.58.s1.17.
