14:35 Uhr
KV-37:
Acute abdominal pain in children and adolescents – a risk-based management including enemas
J. Schultz (Dresden, DE)
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Autor:innen:
J. Schultz (Dresden, DE)
B. Groß (Dresden, DE)
K. Lipinska (Dresden, DE)
G. Fitze (Dresden, DE)
Aim: Abdominal pain is a widespread symptom in childhood and adolescence where frequency, threat, and causes are disparate. Despite the impact of abdominal pain in emergency departments, no standard risk assessment for children with acute abdominal pain has been established. Here we retrospectively examined patients who presented with acute abdominal pain to identify risk factors for immediately dangerous causes requiring urgent surgical therapy. This study aimed not to predict precise diagnoses but to distinguish dangerous from non-dangerous abdominal pain at an early stage.
Methods: We first screened 7,831 patient records for ICD diagnosis related to abdominal pain. We then analyzed 1723 patients of 3-17 years with acute abdominal pain as presenting complaint in the emergency room of our tertiary pediatric surgery between 2018-2019. We analyzed patients' clinical data, secondary symptoms, diagnosis, therapy, and clinical outcomes.
Results: We identified 175 ICD codes associated with abdominal pain in children or adolescents. Abdominal pain accounted for 7.4% of emergency presentations in the Department of Pediatric Surgery. 71% of emergency patients with abdominal pain did not need surgery or inpatient admission. While almost 29% of our patients required inpatient admission, only 11.8% underwent surgery. Most symptoms and findings proved unsuitable for assessing the severity of the underlying disease. Only abdominal rigidity and pain migration typical for appendicitis proved statistically significant and practically relevant. After administering an enema to patients without red flags, 78.4% left the emergency department free of complaints without later representations or surgery. In addition, we recorded no complications after enemas.
Conclusion: Most accompanying symptoms, such as nausea, vomiting, fever, or diarrhea, are unsuitable for distinguishing between dangerous and non-dangerous causes of abdominal pain. In otherwise healthy patients without relevant pre-existing conditions, an enema can be given to children and adolescents presenting with abdominal pain if there is no abdominal rigidity or typical migration of pain. No further diagnostic work-up is immediately necessary when patients are free of complaints after passing an enema-prompted bowel motion. This management, suitable for most outpatient practices, could help spare the patients from unnecessary diagnostics and preserve health system resources.