FACTORS AFFECTING LENGTH OF STAY IN PATIENTS WITH ABDOMINAL PAIN IN EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL, KARACHI

Abstract

Objective: To determine the length of stay (LOS) in the emergency department (ED) among adult patients presenting with acute abdominal pain and to identify clinical and operational predictors of prolonged stay in a high-volume tertiary care hospital in Pakistan.

Study Design: Descriptive cross-sectional study..

Study Setting: Emergency Department of Indus Hospital and Health Network, Karachi, Pakistan.

Study Duration: Six Months (February’24 to July‘24).

Methodology: A total of 498 adult patients presenting with acute abdominal pain were included through consecutive non-probability sampling. Data regarding demographics, clinical presentation, diagnostic investigations, consultations, and ED processes was collected. Prolonged LOS was defined as more than 6 hours. Statistical analysis was performed using logistic regression to identify predictors of prolonged stay.

Results: The median ED LOS was 5.2 hours (IQR: 3.2–7.6), with 42.4% of patients experiencing prolonged stay. Significant independent predictors of prolonged LOS included inter-departmental consultations (aOR up to 28.66), multiple rounds of blood testing (aOR up to 17.76), use of whole-abdomen ultrasonography (aOR 3.63), and higher pain scores (aOR 1.60 per unit increase) (p<0.05). Demographic variables and shift timing were not significantly associated. The model showed good predictive ability (AUC = 0.87).

Conclusion: Prolonged ED LOS in patients with acute abdominal pain is primarily driven by operational factors such as multiple consultations, repeated laboratory testing, and imaging delays. Optimizing workflow and promoting efficient diagnostic strategies may help reduce ED overcrowding and improve patient outcomes.