Pediatr Gastroenterol Hepatol Nutr.  2014 Dec;17(4):223-231. 10.5223/pghn.2014.17.4.223.

Systemic Classification for a New Diagnostic Approach to Acute Abdominal Pain in Children

• Kim JH
• Kang HS
• Han KH
• Kim SH
• Shin KS
• Lee MS
• Jeong IH
• Kim YS
• Kang KS

• KMID: 2315496
• DOI: http://doi.org/10.5223/pghn.2014.17.4.223

Abstract

PURPOSE
With previous methods based on only age and location, there are many difficulties in identifying the etiology of acute abdominal pain in children. We sought to develop a new systematic classification of acute abdominal pain and to give some helps to physicians encountering difficulties in diagnoses.
METHODS
From March 2005 to May 2010, clinical data were collected retrospectively from 442 children hospitalized due to acute abdominal pain with no apparent underlying disease. According to the final diagnoses, diseases that caused acute abdominal pain were classified into nine groups.
RESULTS
The nine groups were group I "catastrophic surgical abdomen" (7 patients, 1.6%), group II "acute appendicitis and mesenteric lymphadenitis" (56 patients, 12.7%), group III "intestinal obstruction" (57 patients, 12.9%), group IV "viral and bacterial acute gastroenteritis" (90 patients, 20.4%), group V "peptic ulcer and gastroduodenitis" (66 patients, 14.9%), group VI "hepatobiliary and pancreatic disease" (14 patients, 3.2%), group VII "febrile viral illness and extraintestinal infection" (69 patients, 15.6%), group VIII "functional gastrointestinal disorder (acute manifestation)" (20 patients, 4.5%), and group IX "unclassified acute abdominal pain" (63 patients, 14.3%). Four patients were enrolled in two disease groups each.
CONCLUSION
Patients were distributed unevenly across the nine groups of acute abdominal pain. In particular, the "unclassified abdominal pain" only group was not uncommon. Considering a systemic classification for acute abdominal pain may be helpful in the diagnostic approach in children.

Keyword

Acute abdominal pain; Child; Classification

MeSH Terms

Abdominal Pain*
Appendicitis
Child*
Classification*
Diagnosis
Humans
Retrospective Studies
Ulcer

Figure

• 

  Fig. 1 The incidence of each acute abdominal pain group was variable among the 442 enrolled patients. Group IV, "viral and bacterial acute gastroenteritis (AGE)," was the most common, followed by groups V, IX, VII, II, III, VIII, X, VI, and group I. Group IX, "unclassified acute abdominal pain," showed a relatively high incidence of 14.3%. Group I, "catastrophic surgical abdomen," was rare, with an incidence of 1.7%. FGID: functional gastrointestinal disorder.

Reference

1. Scholer SJ, Pituch K, Orr DP, Dittus RS. Clinical outcomes of children with acute abdominal pain. Pediatrics. 1996; 98:680–685.

2. Marin JR, Alpern ER. Abdominal pain in children. Emerg Med Clin North Am. 2011; 29:401–428. ix–x.

3. McCollough M, Sharieff GQ. Abdominal pain in children. Pediatr Clin North Am. 2006; 53:107–137. vi

4. Kang KS. Acute abdominal pain in children. Korean J Pediatr Gastroenterol Nutr. 2008; 11:Suppl 2. 11–18.

5. Mason JD. The evaluation of acute abdominal pain in children. Emerg Med Clin North Am. 1996; 14:629–643.

6. Leung AK, Sigalet DL. Acute abdominal pain in children. Am Fam Physician. 2003; 67:2321–2326.

7. Balachandran B, Singhi S, Lal S. Emergency management of acute abdomen in children. Indian J Pediatr. 2013; 80:226–234.

8. Boyle JT. Abdominal pain. In : Walker WA, Goulet O, Kleinman RE, Sherman PM, Shneider BL, Sanderson IR, editors. Pediatric gastrointestinal disease. 4th ed. Hamilton: BC Decker Inc.;2004. p. 225–243.

9. Roy CC, Morin CL, Weber AM. Gastrointestinal emergency problems in paediatric practice. Clin Gastroenterol. 1981; 10:225–254.

10. Reynolds SL, Jaffe DM. Children with abdominal pain: evaluation in the pediatric emergency department. Pediatr Emerg Care. 1990; 6:8–12.

11. McNamara R, Dean AJ. Approach to acute abdominal pain. Emerg Med Clin North Am. 2011; 29:159–173. vii

12. Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007; 298:438–451.

13. Kulik DM, Uleryk EM, Maguire JL. Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. J Clin Epidemiol. 2013; 66:95–104.

14. Shin KH, Kim GC, Lee JK, Lee YH, Kam S, Hwang JB. Clinical features of acute nonspecific mesenteric lymphadenitis and factors for differential diagnosis with acute appendicitis. Korean J Pediatr Gastroenterol Nutr. 2004; 7:31–39.

15. Saulsbury FT. Henoch-Schönlein purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore). 1999; 78:395–409.

16. Chang JY, Kim YJ, Kim KS, Kim HJ, Seo JK. Henoch-Schönlein purpura presenting with acute abdominal pain preceding skin rash: review of 23 cases. J Korean Pediatr Soc. 2003; 46:576–584.

17. Oh JM, Park JH. Clinical features of Henoch-Schönlein purpura gastroenteropathy without purpura before diagnosis. Korean J Pediatr Gastroenterol Nutr. 2004; 7:54–60.

18. Erkan T, Cam H, Ozkan HC, Kiray E, Erginoz E, Kutlu T, et al. Clinical spectrum of acute abdominal pain in Turkish pediatric patients: a prospective study. Pediatr Int. 2004; 46:325–329.

19. Hwang JB. Early recognition of high risk factors of acute abdominal pain in children. Korean J Pediat. 2006; 49:117–128.

20. Davenport M. Acute abdominal pain in children. BMJ. 1996; 312:498–501.