CLINICAL PROFILE, DIAGNOSTIC CONCORDANCE AND POSTOPERATIVE OUTCOMES IN ACUTE ABDOMEN: A PROSPECTIVE MULTICENTRE OBSERVATIONAL STUDY

Background: Acute abdomen is among the commonest surgical emergencies and requires prompt evaluation and timely intervention. Although imaging has improved diagnostic precision, structured clinical assessment remains central to emergency surgical decision-making. This study described the clinical profile, diagnostic concordance, operative management and postoperative outcomes of adults presenting with acute abdomen at three tertiary centres. Methods: A prospective multicentre observational study was conducted in the Departments of General Surgery of three tertiary care teaching hospitals in South India. Consecutive adults presenting within 72 hours of symptom onset with a surgically managed cause of acute abdomen were enrolled and underwent standardised clinical evaluation supported by laboratory investigation and imaging as indicated. Concordance  between the provisional diagnosis recorded at first surgical assessment and the final diagnosis, operative findings, postoperative complications, intensive care requirement, length of stay, mortality and overall clinical outcome were recorded. Proportions are reported with 95% Wilson confidence intervals. Reporting follows the STROBE statement. Results: Of 384 patients assessed for eligibility, 324 were enrolled. Two hundred and sixteen (66.7%) were men, with a mean age of 45.6 ± 16.8 years. Acute appendicitis was the commonest final diagnosis (102 patients, 31.5%, 95% CI 26.6-36.8), followed by acute cholecystitis (58, 17.9%), intestinal obstruction (46, 14.2%) and perforation peritonitis (40, 12.3%). The provisional diagnosis agreed with the final diagnosis in 301 of 324 patients, an overall concordance of 92.9% (95% CI 89.6-95.2); concordance was highest for acute appendicitis (98/102, 96.1%) and lowest for mesenteric ischaemia (10/12, 83.3%) and miscellaneous causes (8/10, 80.0%). Laparoscopic procedures were undertaken in 212 patients (65.4%). Mean time from arrival to surgical assessment was 28.4 ± 11.6 minutes and mean operative duration 94.5 ± 31.4 minutes. Surgical site infection occurred in 16 patients (4.9%, 95% CI 3.1-7.9), reoperation in 6 (1.9%) and death in 8 (2.5%, 95% CI 1.3-4.8). Conclusion: Structured clinical assessment supported by laboratory and radiological investigation achieved close agreement with the final diagnosis across a broad range of abdominal emergencies, with lower concordance in the less common conditions where diagnostic uncertainty is greatest. Complication rates and mortality were low. The study was descriptive and uncontrolled: it does not compare operative approaches and was not designed to identify independent predictors of outcome.