ABDOMINAL
PAIN AMONG CHILDREN �C RE-EVALUATION OF A DIAGNOSTIC ALGORITHM
Zhang Jin-zhe, Zhou Hong, and Chen Yi-chen
Surgical Department, Beijing Children��s
Hospital, Beijing, China
Aim: Re-evaluate the
algorithm been used for some 40 years for diagnosis of acute abdominal pain
among children by prospective study of cases admitted to Beijing Children��s
Hospital in 2000.
Material and Method: Nine hundred and
thirty-seven cases which was strictly following the algorithm admitted to
the surgical emergency ward in 2000, and among them 656 cases of acute
appendicitis were studied to evaluate the usefulness of the present
algorithm by its calculated accuracy, false positive and false negative
rate, the sensitivity and specificity in the instant diagnosis of various
type of acute appendicitis of different age groups. The algorithm used is
that established in 1958 and recently revised for this study in 1999. It
includes a 3-step analysis of clinical presentations, i.e.: firstly, to
make a diagnosis of surgical pain by definite organic abdominal signs; then
a diagnosis of the subgroup of surgical condition by special signs; and
finally the diagnosis of the present disease by specific signs. A footnote
describes a ��comparative technique�� of abdominal examination in
non-cooperative children.
Result: The general accuracy of
diagnosis was 94.5%, overall mortality 0.1% among 973 cases of abdominal
pain in 2000. 373 attending surgeons and 241 residents including trainees
joined the diagnosis and treatment with no remarkable difference in the
result. The incidence of acute appendicitis, 656 in 973 cases, was 67.3%
representing the majority of abdominal pain. In the series of 656 cases,
the accuracy of diagnosis of acute appendicitis was 93.6%, false positive
6.4%, false negative 0.9%, sensitivity at first visit 82.7%, specificity
for appendicitis 98.0%, no death or documentary complication.
Conclusion: The present used
algorithm for diagnosis of acute abdominal pain is effective and preferable
in reducing misdiagnosis and maltreatment at emergency. The use of some
modern technology should be further explored.
Key words: Abdominal pain,
diagnostic algorithm, children, appendicitis