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1 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute for Health Care, Indianapolis, Indiana
2 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
3 Department of Medicine, Indiana University School of Medicine, indianapolis, Indiana; Bowen Research Center, indianapolis, Indiana; Regenstrief Institute for Health Care, Indianapolis, Indiana
Address correspondence to: Seth J. Scholer, MD, Division of General Pediafrica, 5028 Medical Center East, 1215 21st Ave. Nashville, TN 37232-8555
Objective. To determine the prevalence, associated symptoms, and clinical outcomes of children presenting for a nonscheduled visit with acute abdominal pain.
Design. Historical cohort.
Setting. Inner-city teaching hospital.
Participants. A total of 1141 consecutive children, ages 2 to 12, presenting for a nonscheduled visit (clinic or emergency department) with a complaint of nontraumatic abdominal pain of 
3 days' duration were identified through a manual chart review.
Measurements. Collected data included: 1) demographic characteristics, 2) presenting signs and symptoms, 3) records from the hospital record for all children who returned within 10 days for follow-up, 4) test results, and 5) telephone follow-up. A clinical reviewer used the data to assign a final diagnosis to each patient.
Results. The prevalence of children presenting with abdominal pain of 3 days' duration was 5.1%. The most common associated symptoms were history of fever (64%), emesis (42.4%), decreased appetite (36.5%), cough (35.6%), headache (29.5%), and sore throat (27.0%). The six most prevalent final diagnoses, accounting for 84% of all final diagnoses, were upper respiratory infection and/or otitis (18.6%), pharyngitis (16.6%), viral syndrome (16.0%), abdominal pain of uncertain etiology (15.6%), gastroenteritis (10.9%), and acute febrile illness (7.8%). Approximately 1% of children required surgical intervention (10/12 for appendicitis). Approximately 7% of children returned within 10 days for reevaluation of their illness; on return, 11 had treatable medical diseases and 4 had diseases requiring surgical intervention.
Conclusions. An acute complaint of abdominal pain in children occurs in 5.1% of nonscheduled visits, is frequently accompanied by multiple complaints, and is usually attributed to a self-limited disease. Close follow-up will identify the 1% to 2% who proceed to have a more serious disease process. This epidemiologic data will aid clinic-based physicians who manage children with acute abdominal pain.
Submitted on April 11, 1995
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