Background

Making accurate decisions for patients with acute abdominal pain (AAP) is difficult. To avoid missing seriously ill patients, many undergo unnecessary surgery, with negative laparotomy rates of 25%. However, delays can lead to 20% perforation rates. Many conditions cause AAP and no single clinical finding or test is both specific and sensitive. Many decision tools (DTs) combining two or more findings have been developed to aid AAP management, but no consensus exists on their appropriateness for clinical use.

Objectives

The study aimed to answer the following questions.

1. What are the diagnostic accuracies of DTs and doctors aided by DTs compared with those of unaided doctors?
2. What is the impact of providing doctors with an AAP DT on patient outcomes, clinical decisions and actions?
3. What factors are likely to determine the usage rates and usability of a DT?
4. What are the associated costs and likely cost-effectiveness of these DTs in routine use in the UK?

Methods

Results

Conclusions

Recommendations for research

This review uncovered important evidence gaps. The authors' research recommendations include the following:

• Primary research to compare paper-based checklists with computer-based tools exploring the type/format that maximises patient benefit.
• Empirical research to identify the determinants of successful DTs, to provide more evidence to support the development of clinically useful tools.
• More general systematic reviews (across a range of diseases or tools) to assess (1) factors that make DTs more acceptable to doctors and patients and (2) the relative clinical value of paper checklists versus computer-based tools.

Publication

• Liu JLY, Wyatt JC, Deeks JJ, Clamp S, Keen J, Verde P, et al. Systematic reviews of clinical decision tools for acute abdominal pain. Health Technol Assess 2006;10(47). [PubMed: 17083855]

NHS R&D HTA Programme

The research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly influence key decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC) who rely on HTA outputs to help raise standards of care. HTA findings also help to improve the quality of the service in the NHS indirectly in that they form a key component of the 'National Knowledge Service' that is being developed to improve the evidence of clinical practice throughout the NHS.

The HTA Programme was set up in 1993. Its role is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care.

The HTA Programme commissions research only on topics where it has identified key gaps in the evidence needed by the NHS. Suggestions for topics are actively sought from people working in the NHS, the public, service-users groups and professional bodies such as Royal Colleges and NHS Trusts.

Research suggestions are carefully considered by panels of independent experts (including service users) whose advice results in a ranked list of recommended research priorities. The HTA Programme then commissions the research team best suited to undertake the work, in the manner most appropriate to find the relevant answers. Some projects may take only months, others need several years to answer the research questions adequately. They may involve synthesising existing evidence or conducting a trial to produce new evidence where none currently exists.

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Criteria for inclusion in the HTA monograph series

Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors.

Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

The research reported in this monograph was commissioned by the HTA Programmeas project number 97/38/03. The contractual start date was in May 2001. The draft report began editorial review in February 2006 and was accepted for publication in March 2006. As the funder, by devising a commissioning brief, the HTA Programme specified the research question and study design. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the referees for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.

The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health.

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