Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 758-764 (doi:10.1542/peds.2008-0227)
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ARTICLE

Pain Symptoms and Stooling Patterns Do Not Drive Diagnostic Costs for Children With Functional Abdominal Pain and Irritable Bowel Syndrome in Primary or Tertiary Care

Mariella M. Lane, PhDa,b, Erica M. Weidler, BAc,d,e, Danita I. Czyzewski, PhDa,b,c and Robert J. Shulman, MDc,d,e

a Menninger Department of Psychiatry and Behavioral Sciences
c Department of Pediatrics, Baylor College of Medicine, Houston, Texas
b Psychiatry and Psychology Service
d Department of Gastroenterology, Texas Children's Hospital, Houston, Texas
e US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Houston, Texas

OBJECTIVE. The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominal pain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for the children in primary versus tertiary care, and (3) examine if symptom characteristics predicted the cost of medical evaluation.

METHODS. Eighty-nine children aged 7 to 10 years with functional abdominal pain or irritable bowel syndrome seen by a gastroenterologist (n = 46) or seen only by a pediatrician (n = 43) completed daily pain and stool diaries for 2 weeks. Mothers provided retrospective reports of their children's symptoms in the previous year. Cost of medical evaluation was calculated via chart review of diagnostic tests and application of prices as if the patients were self-pay.

RESULTS. Child-reported diary data reflected no significant group differences with respect to pain, interference with activities, or stool characteristics. In contrast, mothers of children evaluated by a gastroenterologist viewed their children as having higher maximum pain intensity in the previous year. Excluding endoscopy costs, cost of medical evaluation was fivefold higher for children evaluated by a gastroenterologist, with higher cost across blood work, stool studies, breath testing, and diagnostic imaging. Symptom characteristics did not predict cost of care for either group.

CONCLUSIONS. Despite the lack of difference in symptom characteristics between children in primary and tertiary care, a notable differential in cost of evaluation exists in accordance with level of care. Symptom characteristics do not seem to drive diagnostic evaluation in either primary or tertiary care. Given the lack of differences in child-reported symptoms and the maternal perspective that children evaluated by a gastroenterologist had more severe pain, we speculate that parent perception of child symptoms may be a primary factor in seeking tertiary care.

Key Words: recurrent abdominal pain • chronic abdominal pain • functional abdominal pain • irritable bowel syndrome • gastrointestinal symptoms • cost of care

Abbreviations: RAP—recurrent abdominal pain • FAP—functional abdominal pain • IBS—irritable bowel syndrome • CGI—children evaluated by a gastroenterologist • CP—children remaining under care of pediatrician • VAS—visual analog scale

Accepted Jun 16, 2008.


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