Pediatr Gastroenterol Hepatol Nutr.  2019 May;22(3):225-232. 10.5223/pghn.2019.22.3.225.

Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain

• van Kalleveen MW
• Noordhuis
• Lasham C
• Plötz FB

• KMID: 2444848
• DOI: http://doi.org/10.5223/pghn.2019.22.3.225

Abstract

PURPOSE
To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags.
METHODS
The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and inter-observer variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up.
RESULTS
A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35-0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower inter-observer variability than in the retrospective study. Adherence to the guideline was 66.8%.
CONCLUSION
We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.

Keyword

Guideline adherence; Interobserver variability; Intra-observer variability; Pediatricians; Abdominal pain

MeSH Terms

Abdominal Pain*
Child*
Cohort Studies
Guideline Adherence
Hospitals, Teaching
Humans
Observer Variation
Prospective Studies
Retrospective Studies

Figure

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  Fig. 1 Study flow chart.

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