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The primary care physician's approach to functional abdominal pain in childhood
Mark Fishbein1, Brad Bernard, Christopher Ehrlich
1Department of Pediatrics, SIU School of Medicine, Springfield, IL 62794-9658, USA. mfishbein@siumed.edu
Insights
Pediatric functional abdominal pain evaluations by primary care physicians involved minimal testing, aligning with guidelines. Increased ultrasound use in clinical settings may stem from a need for reassurance rather than diagnosing organic causes.
Area of Science:
- Pediatric Gastroenterology
- Clinical Practice Research
Background:
- Recurrent abdominal pain in children is defined by criteria like Rome II, aiming to understand functional gastrointestinal disorders.
- Lack of specific biomarkers necessitates varied diagnostic approaches for these conditions.
Purpose of the Study:
- To explore primary care physicians' approaches to diagnosing functional abdominal pain in children using Rome II criteria.
- To compare physician diagnostic strategies in hypothetical scenarios versus actual clinical practice.
Main Methods:
- A survey with a clinical vignette was distributed to 201 primary care physicians.
- Physician practices were also assessed via chart reviews of 103 children referred to a gastroenterology clinic.
Main Results:
- Physicians generally favored limited organ-specific testing, with urinalysis being most common.
- Physicians anticipating positive test yields requested significantly more tests.
- Ultrasound use was higher in actual clinical cases (31%) compared to hypothetical ones (18%).
Conclusions:
- Physician-ordered testing for pediatric functional abdominal pain was minimal, consistent with established guidelines.
- The higher frequency of ultrasound in clinical practice might indicate a need for patient reassurance over organic diagnosis.
Background:
Recurrent abdominal pain in children was defined initially by Apley and updated recently by Rome II criteria. The intent of the Rome II criteria is to provide greater insight into functional disorders of the gastrointestinal tract. Because markers for these disorders are lacking, diagnostic evaluations may vary. In this investigation, the individual approach of the primary care physician to the child with functional abdominal pain (as defined by Rome II criteria) is explored both in a hypothetical and clinical setting.
Study:
A clinical vignette and survey involving the evaluation of a school-aged child with prototypical functional abdominal pain was distributed to area primary care physicians (n=201 completed). The actual physician approach for functional abdominal pain was determined through chart review of children referred to gastroenterology clinic (n=103).
Results:
Physicians favored limited organ-specific testing, with urinalysis, preferred most. Physicians with extreme anticipation of a positive yield requested more testing than their nonanticipatory counterparts (5.7+/-2.2 vs. 2.0+/-2.0, P<0.001). Ultrasound was the only diagnostic test requested with greater frequency in actual subjects than hypothetical (31% vs. 18%, P<0.005).
Conclusions:
In accordance with published guidelines, physicians requested minimal testing for functional abdominal pain. Increased ultrasound requests in the clinic setting may be more reflective of the need for reassurance rather than seeking an organic etiology.
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