Early identification of emergency abdominal surgery candidates in the emergency department – a delphi study

Acute high-risk abdominal (AHA) surgery is associated with considerable morbidity and mortality. In the emergency department (ED), early identification of patients requiring AHA surgery remains challenging and is often based on non-standardized clinical judgment. This study aimed to identify clinical indicators that may support the timely recognition of patients in need of emergency abdominal surgery. A modified Delphi study was conducted to achieve expert consensus on early clinical indicators of AHA surgery. Two Delphi rounds were performed. In round one, experienced surgeons and emergency clinicians rated 30 predefined indicators as insignificant, less important, important, or very important. Consensus was defined as ≥ 75% of participants rating an indicator as important or very important. In round two, participants were asked to rank the importance of the indicators rated as “important” or “very important” in round one. A total of 87 surgeons and emergency physicians participated in round one, with 62 (71%) completing round two. Consensus was reached for 11 indicators considered important for identifying AHA patients on arrival in the ED, e.g. acute pain onset within minutes, VAS pain score 6–10, repeated vomiting, and absence of bowel movement within 24 h. In round two, clinicians ranked these indicators; however, no clear consensus emerged regarding their relative prioritisation. This Delphi study identified 11 clinically relevant indicators for the early identification of patients requiring AHA surgery in the ED. The study underscores the complexity of early recognition and supports the need for structured, data-informed screening tools to aid clinical decision-making.