Annals Journal Club: Nonspecific Abdominal Pain in Children

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.OpenUrlAbstract/FREE Full Text

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:

  1. How patients were selected, excluded, or lost to follow-up?

  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?

• 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?