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A thorough history and physical examination, the judicious administration of analgesia, effective use of imaging, and timely surgical consultation can lead to the appropriate diagnosis of the acute abdomen. Clinicians must remain mindful of their biases so that they do not incite processing errors and result in incorrect diagnoses that can lead to morbidity and death.    The Ishikawa fishbone diagram (shown in figure) depicts a cause-and-effect approach, which incorporates attributions and considerations that are essential for achieving a desirable patient-centered outcome. This fishbone diagram represents our how-to guide for achieving a timely evaluation and diagnosis of acute abdominal pain. The diagram shows multiple factors and relates them to one major effect. The main branches identify the primary causes of the effect. The stems of each main branch indicate contributing factors. For example, the surgical consultation branch has a stem labeled “experience.” Other factors could be added, such as the year of residency training or the specialty of the first responder.    Learn more in the Review Article “Acute Abdomen in the Modern Era” by Selwyn O. Rogers Jr., M.D., M.P.H., and Orlando Kirton M.D.: https://nej.md/4cK1QOd 

  • Figure 1. Ishikawa Cause-and-Effect Diagram for Avoiding a Missed Diagnosis in a Patient with Acute Abdominal Pain Warranting Surgical Consultation. 

NSAID denotes nonsteroidal antiinflammatory drug.

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