The Surprising Chronicity of Abdominal Pain in Children
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The *Annals of Family Medicine* encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the *Annals* online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word *radical* also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1

## HOW IT WORKS

In each issue, the *Annals* selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on “TRACK Comments: Submit a response.”) You can find discussion questions and more information online at: [http://www.AnnFamMed.org/AJC/](http://www.AnnFamMed.org/AJC/).

## CURRENT SELECTION

### Article for Discussion

 Lisman-van Leeuwen Y, Spee LAA, Benninga MA, Bierma-Zeinstra SMA, Berger MY. Prognosis of abdominal pain in children in primary care—a prospective cohort study. Ann Fam Med. 2013; 11( 3): 238– 244.[Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvMy8yMzgiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzMvaWlpLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)

### Discussion Tips

This cohort study gives us a chance to see the big picture about abdominal pain in children that otherwise would become apparent only across a professional lifetime and then only with great attention.

### Discussion Questions

*   What are the study’s research questions and hypotheses, and why do they matter?

*   How does this study advance beyond previous research and clinical practice on this topic?

*   How strong is the study design for answering the question?

*   To what degree can the findings be accounted for by:
    
    1.  How patients were selected, excluded, or lost to follow-up over multiple time points?
    
    2.  How the main variables were measured?
    
    3.  Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
    
    4.  Chance?
    
    5.  How the findings were interpreted?

*   How were possible biases controlled for in analyses?

*   How do the sensitivity analyses affect your confidence in the findings?

*   What are the main study findings?

*   Does it surprise you how often pain is chronic among children complaining of abdominal pain?

*   How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?

*   How might the findings of this study affect your diagnostic approach to children complaining of abdominal pain?

*   How might the findings of this study influence how you talk with parents and children complaining of abdominal pain?

*   How might this study change your practice?

*   What researchable questions remain?

*   © 2013 Annals of Family Medicine, Inc.

## References

1.  Stange KC, Miller WL, McLellan LA, et al. *Annals* Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006;4(3):196–197. [http://annfammed.org/cgi/content/full/4/3/196](http://annfammed.org/cgi/content/full/4/3/196).
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIzOiIvYW5uYWxzZm0vMTEvMy9paWkuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)