medicina61巻11号

2024年10月発行

増大号特集 続・Quality Indicatorの実装とその改善—日々の診療に役立つ診療評価指標

各論　女性診療

女性の腹痛の評価指標

著者： 柴田綾子¹

所属機関： ¹淀川キリスト教病院産婦人科

ページ範囲：P.1917 - P.1919

文献概要

Point
◎女性の腹痛では非特異的腹痛の割合が多い．
◎腹痛の位置，ペインスケール，発症様式，性状，痛みの移動の有無を確認する．
◎有月経者では妊娠反応検査を推奨し，超音波検査が第一選択となる．
◎鎮痛薬による痛みの治療も重要である．

参考文献

1）Cervellin G, et al：Epidemiology and outcomes of acute abdominal pain in a large urban emergency department；Retrospective analysis of 5,340 cases. Ann Transl Med 4：362, 2016 PMID 27826565

2）Murata A, et al：Age-related differences in outcomes and etiologies of acute abdominal pain based on a national administrative database. Tohoku J Exp Med 233：9-15, 2014 PMID 24739505

3）急性腹症診療ガイドライン出版委員会（編）：急性腹症診療ガイドライン2015．医学書院，2015

4）American College of Emergency Physicians：Clinical policy；Critical issues for the initial evaluation and management of patients presenting with a chief complaint of nontraumatic acute abdominal pain. Ann Emerg Med 36：406-415, 2000 PMID 11020699

5）Schuur JD, et al：Pregnancy testing in women of reproductive age in US emergency departments, 2002 to 2006；Assessment of a national quality measure. Ann Emerg Med 55：449-457.e2, 2010 PMID 19931941

6）Hogan S, et al：The utility of the abdominal series in the emergency setting；A retrospective review. Int J Emerg Med 17：6, 2024 PMID 38178037

7）Dupriez F, et al：Evaluation of point-of-care ultrasound use in the diagnostic approach for right upper quadrant abdominal pain management in the emergency department；A prospective study. Intern Emerg Med 19：803-811, 2024 PMID 38041765

8）Richardson A, et al：Accuracy of first-trimester ultrasound in diagnosis of tubal ectopic pregnancy in the absence of an obvious extrauterine embryo；Systematic review and meta-analysis. Ultrasound Obstet Gynecol 47：28-37, 2016 PMID 25766776

9）American Academy of Family Physicians：Choosing Wisely Recommendations；Avoid using CT scan as the first-line imaging modality in the evaluation of suspected appendicitis in children. Ultrasound should be done first with a CT scan or MRI considered in equivocal cases.　https://www.aafp.org/pubs/afp/collections/choosing-wisely/416.html（2024年8月閲覧）

10）Wang RC, et al：Trends in use of diagnostic imaging for abdominal pain in U.S. Emergency Departments. AJR Am J Roentgenol 216：200-208, 2021 PMID 33211574

11）Stang AS, et al：Quality indicators for the assessment and management of pain in the emergency department；A systematic review. Pain Res Manag 19：e179-e190, 2014 PMID 25337856

12）Manterola C, et al：Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev 1：CD005660, 2011 PMID 21249672

13）Osterwalder I, et al：Acute abdominal pain；Missed diagnoses, extra-abdominal conditions, and outcomes. J Clin Med 9：899, 2020 PMID 32218137