P0728 CLINICAL OUTCOMES OF CHILDREN WITH ACUTE ABDOMINAL PAIN IN OUTPATIENTS: ANALYSIS OF RISK FACTORS OF HIGH RISK ETIOLOGIES

Abstract

Introduction: Acute abdominal pain in children presents a diagnostic dilemma. Although many cases are benign, some require a rapid diagnosis and treatment in order to minimize morbidity. The clinical outcomes of children presenting with acute abdominal pain in a outpatients clinic were determined, and the risk factors of the high risk etiologies were analyzed. Methods: Between January 2002 and June 2002, data from 244 consecutive patients, aged 1 to 13 years, in a pediatric gastroenterology outpatient visit with acute nontraumatic abdominal pain was reviewed. Abdominal ultrasonography was performed in all patients after receiving parental consent. The high risk etiologies were defined as a surgical or medical emergency. The nine risk factors were analyzed; a sick appearance, the symptom duration, the vomiting intensity, the diarrhea intensity, fever, nocturnal pain, colic pain, periodic pain, and localized pain. Results: Of the 244 patients, the six most prevalent final diagnoses were mesenteric adenitis (16.3%), an uncertain etiology (11.8%), pharyngitis (9.4%), constipation (9.0%), pneumonia (8.6%), and bacterial enteritis (6.5%). Approximately 14.8% of the patients were identified as having high risk etiologies and a surgical emergency occurred in 5.7%. The six most prevalent high risk etiologies were intussusception (4.1%), appendicitis (2.9%), hemorrhagic gastritis (2.0%), paralytic ileus (1.6%), hydronephrosis (1.2%), and allergic purpura (0.8%). The high risk factors were 8 with the exception of fever (P <0.05); a sick appearance (odds ratio [OR],4.93), a symptom duration > 72 hours (OR,4.49), a vomiting intensity > 3/day (OR,7.85), a diarrhea intensity > 3/day (OR,3.85), nocturnal pain (OR,4.72), colic pain (OR,4.03), periodic pain (OR,3.37), and localized pain (OR,2.85). Multiple logistic regression analysis showed that the independent predictors of high risks were a symptom duration > 72 hours (OR,1.68) and a vomiting intensity > 3/day (OR,2.44). Multiple logistic regression analysis also showed that with the exception of constipation, the independent predictors were a sick appearance (OR,2.69), a symptom duration > 72 hours (OR,1.53), a vomiting intensity > 3/day (OR,2.07), and localized pain (OR,3.65). Conclusion: The incidence of high risk etiologies in children with acute abdominal pain in pediatric gastroenterology outpatients is approximately 15%, and 6% of cases involve a surgical emergency. The independent predictors of a high risk are a symptom duration > 72 hours and a vomiting intensity > 3/day. With the exception of constipation, a sick appearance and localized pain are also independent predictors of a high risk.