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Clinical outcomes of children with acute abdominal pain
S J Scholer1, K Pituch, D P Orr
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
Insights
Acute abdominal pain in children affects 5.1% of nonscheduled visits and is often linked to self-limiting conditions. Careful follow-up identifies the few cases requiring intervention for serious diseases.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Epidemiology
Background:
- Acute abdominal pain is a common reason for pediatric nonscheduled visits.
- Understanding its prevalence, symptoms, and outcomes is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of acute abdominal pain in children presenting for nonscheduled visits.
- To identify associated symptoms and clinical outcomes.
- To provide epidemiologic data for physicians managing pediatric abdominal pain.
Main Methods:
- Historical cohort study of 1141 children (ages 2-12) with acute abdominal pain (< or = 3 days duration).
- Data collected via manual chart review, including demographics, symptoms, test results, and follow-up records.
- Clinical reviewer assigned final diagnoses.
Main Results:
- Prevalence of acute abdominal pain was 5.1%.
- Common symptoms included fever (64%), emesis (42.4%), and decreased appetite (36.5%).
- Most frequent diagnoses were upper respiratory infection/otitis (18.6%), pharyngitis (16.6%), and viral syndrome (16.0%).
- Only 1% required surgery (mostly appendicitis); 7% returned for reevaluation, with a small percentage having serious conditions.
Conclusions:
- Acute abdominal pain in children is common and usually self-limiting.
- Close follow-up is essential to identify the 1-2% with serious underlying diseases.
- Epidemiologic data aids physicians in managing pediatric acute abdominal pain.
Objective:
To determine the prevalence, associated symptoms, and clinical outcomes of children presenting for a nonscheduled visit with acute abdominal pain.
Design:
Historical cohort.
Setting:
Inner-city teaching hospital.
Participants:
A total of 1141 consecutive children, ages 2 to 12, presenting for a nonscheduled visit (clinic or emergency department) with a complaint of nontraumatic abdominal pain of < or = 3 days' duration were identified through a manual chart review.
Measurements:
Collected data included: 1) demographic characteristics, 2) presenting signs and symptoms, 3) records from the hospital record for all children who returned within 10 days for follow-up, 4) test results, and 5) telephone follow-up. A clinical reviewer used the data to assign a final diagnosis to each patient.
Results:
The prevalence of children presenting with abdominal pain of < or = 3 days' duration was 5.1%. The most common associated symptoms were history of fever (64%), emesis (42.4%), decreased appetite (36.5%), cough (35.6%), headache (29.5%), and sore throat (27.0%). The six most prevalent final diagnoses, accounting for 84% of all final diagnoses, were upper respiratory infection and/or otitis (18.6%), pharyngitis (16.6%), viral syndrome (16.0%), abdominal pain of uncertain etiology (15.6%), gastroenteritis (10.9%), and acute febrile illness (7.8%). Approximately 1% of children required surgical intervention (10/12 for appendicitis). Approximately 7% of children returned within 10 days for reevaluation of their illness; on return, 11 had treatable medical diseases and 4 had diseases requiring surgical intervention.
Conclusions:
An acute complaint of abdominal pain in children occurs in 5.1% of nonscheduled visits, is frequently accompanied by multiple complaints, and is usually attributed to a self-limited disease. Close follow-up will identify the 1% to 2% who proceed to have a more serious disease process. This epidemiologic data will aid clinic-based physicians who manage children with acute abdominal pain.