Review Article Dig Surg 2015;32:23–31 DOI: 10.1159/000371583 Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

nostic accuracy of clinical assessment is insufficient to iden-tify the correct diagnosis but can discriminate between ur-gent and nonurgent causes. Patients suspected of nonurgent diagnoses can safely be reevaluated the next day. Based on current literature, no conclusions can be drawn on the differ-ences in accuracy between residents and specialists. No con-clusions can be drawn on the influence of a gynecological consultation. In patients suspected of an urgent condition, additional imaging is justified. CRP and WBC count alone are insufficient to discriminate urgent from nonurgent diagno-ses. Diagnostic imaging: There is no place for conventional radiography in the work-up of patients with acute abdomi-nal pain due to the lack of added value on top of clinical as-sessment. Computed tomography leads to the highest sen-sitivity and specificity in patients with acute abdominal pain. Positive predictive value of ultrasound is comparable with CT and therefore preferred as the first imaging modality due to the downsides of computed tomography; negative or in-conclusive ultrasound is followed by CT. Based on current literature, no conclusions can be drawn on the added value of a diagnostic laparoscopy in the work-up of patients with acute abdominal pain. Antibiotic treatment should be start-ed within the first hour after recognition of sepsis. Adminis-tration of opioids (analgesics) decreases the intensity of the pain and does not affect the accuracy of physical examina