Identifying Diagnostic Gaps and Mitigation Strategies for Older Adult Emergency General Surgery Patients: A Scoping Review

BACKGROUND: Older adults undergoing emergency general surgery (EGS) experience disparity and often present in more complex states of health where errors in diagnosis can have profound impact on subsequent treatment options and outcomes. Diagnosis lags in older adult EGS and remains understudied. This scoping review aimed to identify current diagnostic challenges and mitigation strategies to improve diagnosis in the older adult EGS setting. STUDY DESIGN: This scoping review was conducted in accordance with the Meta-Analysis extension for Scoping Reviews and Joanna Briggs and Preferred Reporting Items for Systematic Reviews frameworks. PubMed, Embase, Cochrane Library, and Scopus were searched on December 21, 2023. The search included patients 65 years of age and older undergoing evaluation, and medical and/or surgical management of an EGS condition. Data extracted included specific challenges, clinical tools, and clinician feedback strategies in older adult EGS. RESULTS: Of the 9,170 articles screened, 39 studies met inclusion criteria. Diagnostic challenges contributing to poor outcomes included atypical clinical presentation, delay in diagnosis, and the need for comprehensive risk assessment. Diagnostic tools included validated risk assessments for frailty, comorbidity burden, specific EGS conditions, and delirium; imaging; and serum markers. Evidence on performance feedback in this setting was limited, with 1 study showing that establishing an audit and feedback system in a geriatric short-term care unit led to improved compliance and quality of documentation. CONCLUSIONS: Although there are tools that can mitigate the diagnostic challenges unique in older adult EGS, further efforts are needed to effectively integrate tools and feedback strategies into frontline care.