Article Figures & Data
Figures
- Figure 1.
Incidence of nonspecific abdominal pain in children ages 4 to 17 years by sex in family practice.
Tables
Patient Sex Incidence % (95%CI) n Prevalence % (95%CI) n Note: Total = 59,203; age range = 4 to 17 years. Male 20.3 (18.8–22.0) 615 27.3 (25.5–29.2) 827 Female 29.9 (28.0–31.9) 865 39.8 (37.6–42.1) 1,151 All 25.0 (23.7–26.3) 1,480 33.4 (32.0–34.9) 1,978 Characteristic No NSAP (n=38,803) NSAP (n=1,978) Univariate OR (95% CI) Multivariate OR (95% CI) NSAP=nonspecific abdominal pain; OR = odds ratio. Note: Reference category for each row is children without NSAP. a P <.05. Logistic regression analyses was used to test the association. Age, mean (SD), y 10.4 (3.8) 10.4 (3.8) 1.0 (0.99–1.01) – Female, % 49.4 58.2 1.4 (1.3–1.6) 1.4 (1.3–1.5)a Psychological problem, % 6.6 6.9 1.1 (0.9–1.3) – Social problem, % 0.8 1.3 1.6 (1.1–2.4) 1.4 (0.9–2.1) Nongastrointestinal-nonspecific symptoms, % 5.0 7.2 1.5 (1.2–1.8) 1.3 (1.1–1.5)a Health care use, visits, mean (SD), No. 3.9 (3.9) 4.6 (4.7) 1.05 (1.04–1.06) 1.04 (1.03–1.05)a Management NSAP (n=2 632) Other Problems (n=156 048) NSAP=nonspecific abdominal pain. a P <.01, calculated using Pearson χ2 test. b P <.05, calculated using Pearson χ2 test. No prescription, no referral, % 73.7 49.7a Prescription, % 21.3 45.3a Referral, % 5.0 5.1b - Table 4.
Family Physicians’ Management During Consecutive Visits for Incident Cases of Nonspecific Abdominal Pain
Management 1st Visit (n=1,480) 2nd Visit (n=324) ≥3 Visits (n=184) NSAID=nonsteroidal anti-inflammatory drug. a Percentages from the total number of visits with a prescription. Prescription, No. (%) 260 (17.6) 90 (27.8) 75 (40.8) Drugs for acid-related disorders, %a 13.1 4.4 1.3 Antispasmodics, %a 29.2 26.7 24.0 Laxatives, %a 25.0 32.2 37.3 Osmotic laxatives (lactulose), %a 11.2 15.6 10 Bulking agents (psyllium), %a 12.7 14.4 14.0 Others, %a 1.2 2.0 4.0 Painkillers NSAIDs, %a 5.4 14.4 14.7 Painkillers Analgesics, %a 3.8 4.4 5.3 Anti-infective agents, %a 6.9 5.6 1.3 Additional testing, No. (% ) 16 (1.1) 9 (2.8) 0 Referral, No. (% ) 45 (3.0) 19 (5.6) 5 (2.7) Pediatrician 5 8 3 Surgeon 24 2 0 Radiology 0 1 0 Psychiatrist 1 0 0 Gynecologist 2 1 1 Cardiologist 1 1 0 Urologist 0 1 0 Physiotherapist 2 2 0 Dietician 2 1 0 Unknown 2 1 1 Other 6 1 0
The Article in Brief
Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management
Marieke J. Gieteling , and colleagues
Background Abdominal pain is a common complaint in children and is not usually associated with disease. Little is known about primary care treatment of nonspecific abdominal pain (NSAP, that is, abdominal pain unrelated to disease). This study examines treatment of childhood NSAP by family physicians.
What This Study Found This common complaint is usually resolved in 1 to 2 visits without diagnostic tests or referral to a specialist. Despite the lack of evidence for effectiveness, family physicians frequently prescribe laxatives and antidepressants for these patients. Analyzing data from the Second Dutch National Survey of General Practice, researchers found NSAP has an incidence rate of 25 per 1,000 person years, making it 1 of the 10 most commonly seen complaints of children in Dutch family practice. In the study�s 1,480 children with newly diagnosed NSAP, less than 7% consulted more than twice for the problem. Family physicians referred these patients to specialist care in only 5% of visits, and they prescribed medication in 21%.
Annals Journal Club:
Jul/Aug 2011
Nonspecific Abdominal Pain in Children
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.1How 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/.
CURRENT SELECTION
Article for Discussion
- Gieteling MJ, Lisman-van Leeuwen Y, van der Wouden JC, Schellevis FG, Berger MY. Childhood nonspecific abdominal pain in family practice: incidence, associated factors, and management. Ann Fam Med. 2011;9(4):337-343.
Discussion Tips
Nonspecific symptoms, which are incredibly common, appear at the interface of health and illness. One of the major benefits of primary care is the ability to work effectively at this interface, yet much of this vital work is relegated to the �art� of medicine. This study provides data to inform one common class of presenting symptom complex.
Discussion Questions
- What question is asked by this study and why does it 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:
- How patients were selected, excluded, or lost to follow-up?
- How the main variables were measured?
- Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
- Chance?
- How the findings were interpreted?
- What are the main study findings?
- How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?
- What contextual factors are important for interpreting the findings?
- How might this study change your practice? Policy? Education? Research?
- How might the vital function of family medicine in managing patients� nonspecific symptoms over time be recognized and valued amidst the current hegemony of disease-based quality and pay-for performance measures?
- What are the next steps in interpreting or applying the findings?
- What researchable questions remain?
References
- 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.
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