In this issue of EM Practice Guidelines Update, we review a total of 6 guidelines that address the diagnosis and management of abdominal pain. Abdominal pain is a frequent and potentially high-risk chief complaint. Patients with abdominal pain compose roughly 7% of annual US emergency department (ED) visits and remain a common cause of malpractice claims against emergency physicians.¹ Growing awareness of the adverse consequences of radiographic imaging,^2,3 as well as of intravenous (IV) contrast,⁴ further adds to the challenges faced by the emergency clinician managing this common complaint. Although the recommendations contained within these guidelines direct decisionmaking when evaluating the patient with abdominal pain, it should be noted that 1 of these guidelines has been rescinded as of October 2009. The American College of Emergency Physicians (ACEP) updates its clinical policies on a regular basis, and the policy on abdominal pain published in 2000 in the Annals of Emergency Medicine is no longer available on the ACEP website. This should highlight the fact that an important component of guideline utilization is to determine the date of publication and the effect that this may have on current applicability to patient care. Because a number of issues discussed in this older policy remain relevant and not fully addressed or revised in the latest policy, we briefly discuss these here, with the caveat that readers should understand that ACEP considers this clinical policy outdated.

Practice Guideline Impact

• Clinical findings can be used to support a reduction in radiographic imaging; the use of laboratory tests and clinical information together may reduce post-test probability to a level below a radiographic testing threshold in many patients.
• The benefit of using IV and/or oral contrast is controversial, and practice patterns are determined primarily by institutional preference.
• Aggressive analgesia with opiates early in the course of patients presenting with abdominal pain is an acceptable and appropriate policy.