Acute abdominal pain in children: an analysis of admissions over a three year period
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1Department of Paediatric Surgery, Princess Margaret Hospital for Children, Perth, Australia.
Insights
A quality audit of pediatric surgical cases found that only 35% of children with acute abdominal pain required surgery. Most were diagnosed with non-specific abdominal pain, highlighting the need for careful evaluation in pediatric surgery referrals.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Audit
Background:
- Acute abdominal pain is a common reason for pediatric surgical consultation.
- Accurate diagnosis and appropriate surgical intervention are crucial for pediatric patients.
Purpose of the Study:
- To audit the quality of care for children admitted with acute abdominal pain.
- To determine the proportion of pediatric patients requiring surgical intervention for abdominal pain.
Main Methods:
- Retrospective quality audit of case records.
- Inclusion of 1313 children admitted with acute abdominal pain over three years.
- Analysis of diagnoses, surgical interventions, and outcomes.
Main Results:
- 54% of patients were discharged without surgery, most with non-specific abdominal pain (NSAP).
- Appendicitis was confirmed in 74% of surgically treated patients; 3.7% had other surgical causes.
- Only 35% of referred children ultimately required surgery; 10% had exploratory laparotomy with normal findings.
Conclusions:
- A significant proportion of pediatric surgical referrals for abdominal pain do not result in surgery.
- Non-specific abdominal pain is the most common diagnosis in children not undergoing surgery.
- Careful clinical assessment is essential to optimize surgical intervention rates and patient outcomes.
Abstract:
A quality audit was performed of the case records of 1313 children admitted with acute abdominal pain over a three year period under the care of paediatric surgeons at the Princess Margaret Hospital for Children, Perth. Fifty-four per cent (n = 714) of the patients were discharged without surgical intervention; in this group the most frequent (70%, n = 503) diagnosis was non-specific abdominal pain (NSAP). Of those children having surgery, 74% (n = 443) had appendicitis proven on histopathology; the remaining appendices (n = 134) were reported as normal and no other surgical cause for the patients symptoms were identified. Only 3.7% (n = 22) of children having surgery had another surgical cause for their pain. Of this group, 11 had adnexal pathology, eight had complications of a Meckel's diverticulum and three had torsion of the omentum. There were no deaths in this series, and 39 patients (3%) had wound infections. Based on these results, only 35% of children referred to a surgeon with abdominal pain will actually require surgical intervention, although as a consequence of concern over clinical status an additional 10% will have a laparotomy with normal findings.