Elsevier

Journal of Pediatric Surgery

Volume 49, Issue 11, November 2014, Pages 1602-1604
Journal of Pediatric Surgery

Original Article
Nonspecific abdominal pain is a safe diagnosis

https://doi.org/10.1016/j.jpedsurg.2014.06.014Get rights and content

Abstract

Aim

The aim of this study is to assess if a clinical diagnosis of nonspecific abdominal pain (NSAP) is safe and if patients with this initial diagnosis are likely to require further investigation or surgical intervention.

Methods

3323 patients admitted with NSAP from July 1990 to September 2012 utilizing a prospective database of all surgical admissions were included. Readmission over the period of the study and specifically within 30 days of their initial presentation was identified together with any invasive investigation or surgical intervention.

Main results

319 children (9.6%) were subsequently readmitted with abdominal pain at some point during the study period. Of these, 78 (2.3%) were readmitted within 30 days. 118 (3.5%) children subsequently had an operation or invasive investigation some point following their initial admission. Of these 33 (0.6%) had the procedure within 3 months of the initial admission. 13 patients had an appendicectomy within 3 months of the initial presentation. Of these histology confirmed appendicitis in 8 patients. This gives an overall incidence of “missed” appendicitis of 0.2 % (8/3323).

Conclusion

This study confirms that a clinical diagnosis of nonspecific abdominal pain (NSAP) is safe in a pediatric population and the risk of “missing” appendicitis is only 0.2%. Patients and/or parents can be confidently reassured that the risk of missing organic pathology is very low.

Section snippets

Patients and methods

The geographical location of the Surgical unit at the Royal Aberdeen Children's Hospital (RACH) makes it is the sole pediatric surgical unit receiving emergency surgical admissions from the childhood population of Grampian region. It admits all children under 16 years of age plus some older patients with significant developmental delay. Patients are admitted directly following referral from the general practitioner, or via self presentation to the emergency department. The bespoke Expandable

Results

Of these 32,534 admissions, 14,467 (44.5%) were emergency admissions. Of note 1314 patients were diagnosed with appendicitis in that period, of which 1289 underwent appendicectomy (4.0% of elective and emergency population).

3323 (23%) of the 14,467 emergency admissions had a discharge diagnosis of nonspecific abdominal pain (NSAP). The mean age of patients admitted as an emergency with NSAP was 9.7 (range 0.1–16.2). Male to female admissions were 1745:1578 (M:F = 1:1.1) and the average length of

Discussion

This study used prospectively collected, population-based data to record and assess admissions to a single surgical unit over a 22 year period. There were three main outcomes. Firstly, 23% of emergency surgical admissions had a discharge diagnosis of NSAP. Secondly at 2.3%, there is a low <30 day readmission rate for patients diagnosed with NSAP. Thirdly, a very small proportion of children (0.6%) diagnosed with NSAP required further invasive investigations or operative procedures within 3 months

Acknowledgments

The authors would like to thank Professor Youngson for initiating the EMAS database and expert assistance with preparation of the manuscript.

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