Undifferentiated Abdominal Pain in Children Presenting to the Pediatric Emergency Department

Abstract

Although common, little is known about the characteristics and management of undifferentiated abdominal pain (UAP) in the pediatric emergency department (ED). This study was a 12-month retrospective study for “abdominal pain” ED visits. Patients without an identifiable diagnosis were categorized as “UAP,” while others with identified disease processes were categorized as “structural gastrointestinal diagnosis (SGID).” We included 2383 (72%) visits with 869 (36.5%) UAP visits and 1514 (63.5%) SGID visits. SGID patients had more laboratory tests (811 [53.6%] vs 422 [48.6%], P = .0186), and often had multiple tests performed (565 [69.7%] vs 264 [62.6%], P = .0116). Computed tomography and ultrasound scans were more common in SGID (computed tomography: 108 [7.1%] vs 27 [3.1%], P = .0004; ultrasound: 377 [24.9%] vs 172 [19.9%], P = .0044), and laboratory results (white blood cell count, hemoglobin, albumin, C-reactive protein) were abnormal at significantly higher rates. Analyses revealed the duration of pain as primary covariate in variance of pain etiology. Clinical features, such as duration of pain, may be augmented by laboratory tests to facilitate recognition of UAP in the ED.

Determining clinical predictors to identify non‐specific abdominal pain and the added value of laboratory examinations: A prospective derivation study in a paediatric emergency department

“…The frequency of NSAP and other diagnoses classified as organic pain in our cohort, such as appendicitis and mesenteric lymphadenitis confirmed by abdominal US, were similar to PED diagnoses reported in Iceland and the United States 2,4 . The main difficulty when diagnosing NSAP in PED is that the clinical description of pain and the associated symptoms are neither specific nor homogenous.…”

“…The frequency of NSAP and other diagnoses classified as organic pain in our cohort, such as appendicitis and mesenteric lymphadenitis confirmed by abdominal US, were similar to PED diagnoses reported in Iceland and the United States. 2,4 The main difficulty when diagnosing NSAP in PED is that the clinical description of pain and the associated symptoms are neither specific nor homogenous. The clinical variables we found to discriminate NSAP from organic pain summarise actually characteristics that are not associated with NSAP: pain in the epigastric region and pain migration are associated with gastric disorders and appendicitis (representing 42% of the organic pain group).…”

“…2,3 Diagnosing NSAP in PED is challenging, because the symptoms presented by children are neither specific nor homogenous. 4,5 Nevertheless, most children with NSAP recover with little to no intervention. 6,7 NSAP has a significant medical and economic burden on PED.…”

Hyoscine butylbromide versus acetaminophen for nonspecific colicky abdominal pain in children: a randomized controlled trial

“…In our study, the median length of stay was more than 3.5 hours in both groups, consistent with data from a US cohort of children with "undifferentiated" abdominal pain (3.4 h). 5 We did not record the number of diagnostic tests, but tests may have contributed to length of stay, 55,56 and triagebased directives may facilitate more timely analgesia and discharge. 57 Future studies should explore the effectiveness of a higher dosage of hyoscine butylbromide (20 mg), hyoscine patches or combining pharmacologic therapies with nonpharmacologic strategies such as cognitive behaviour therapy.…”

Peritoneal Tuberculosis in Children Over the Last Decade: A Systematic Literature Review

“…Unfortunately, for half of the patients included in this review it was negative, that shows it is not enough speci c test for peritoneal TB. Although, Quantiferon test, also known as interferon-γ release assay, is reported to be more speci c then tuberculin skin test [17], with the sensitivity of 93.1% and speci city -76.7% [18], it was performed for only 2 patients.…”