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Validation of red flags in the workup of children with long-term abdominal pain - A retrospective study
Malin Delin1, Staffan K Berglund1,2
1Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Insights
Red flags effectively identify inflammatory bowel disease in children with long-term abdominal pain but are less reliable for diagnosing celiac disease or other organic conditions. Further research into biomarkers is needed.
Area of Science:
- Pediatric gastroenterology
- Diagnostic accuracy studies
Background:
- Functional Gastrointestinal Disorders (FGID) are common in children with chronic abdominal pain.
- Distinguishing FGID from organic diseases is clinically challenging.
- Red flags are clinical indicators used to identify serious underlying conditions.
Purpose of the Study:
- To assess the utility of red flags in differentiating organic diseases from FGID in pediatric patients.
- To evaluate the diagnostic performance of red flags for specific non-FGID conditions.
Main Methods:
- Retrospective analysis of 317 children with long-term abdominal pain referred to Swedish pediatric clinics (2011-2012).
- Review of medical records to document red flags at initial consultation.
- Noting final diagnoses after a 1-year follow-up period.
Main Results:
- 10.1% of cases were diagnosed with a non-FGID disease.
- Red flags demonstrated 100% sensitivity and 64.1% specificity for inflammatory bowel disease (IBD).
- Sensitivity and specificity for celiac disease were 45.5% and 63.7%, respectively. Overall non-FGID detection had 59.4% sensitivity and 65.6% specificity.
Conclusions:
- Red flags are highly sensitive for detecting IBD but have limited value for diagnosing celiac disease and other organic diseases in children with chronic abdominal pain.
- The overall specificity of red flags for non-FGID conditions is low.
- Development of novel biomarkers is crucial for improved diagnostic accuracy in pediatric abdominal pain evaluations.
Aim:
To evaluate red flags as an instrument to distinguish other medical conditions from Functional Gastrointestinal Disorders (FGID) in children with long-term abdominal pain.
Methods:
In a retrospective follow-up, data were collected from 317 children who were referred for medical assessment due to long-term abdominal pain between the years 2011 and 2012 at three Swedish paediatric open clinic units in Sweden. Throughout the review of medical records, any documented red flags at the primary consultation and finally set diagnosis after 1 year were noted for all cases.
Results:
A non-FGID disease was diagnosed in 32 cases (10.1%). The sensitivity of red flags to predict inflammatory bowel disease (IBD) was 100% and the specificity 64.1%. The sensitivity of red flags to predict celiac disease was 45.5% and the specificity 63.7%. The sensitivity of red flags to predict any non-FGID disease was 59.4%, and the specificity was 65.6%.
Conclusion:
The use of red flags is a sensitive instrument to identify patients with IBD but less applicable when identifying celiac disease and other organic diseases. Specificity is generally low and future biomarkers for assessing children with long-term abdominal pain is needed.
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