| Objective:Acute or paroxysmal abdominal pain is a common complaint of children in the pediatric out-patient(emergency)department,which contains complex and various etiologies.Timely and accurately diagnosis will help pediatrician take further treatment and reduce misdiagnosis.Based on the interrogation principle of children with acute or paroxysmal abdominal pain as well as the previous etiological classifications,in this study we categorized the pain into five groups.We grouped 814 cases of children with acute or paroxysmal abdominal pain with five group classification,calculated the composition of the different etiologies,summarized the clinical characters,as well as analyzed the advantages and disadvantages of the five group classification with the traditional classifications.The study purpose is to optimize the clinical diagnosis system on abdominal pain in children,and try to improve the treatment efficiency.Statistics and Methods:Statistics: We retrospectively collected 703 cases admitted inpatient and 111 cases from gastroenterology outpatient department dating from Feb.2015 to Jun.2016,in Children's Hospital of Soochow University.They were all with the acute or paroxysmal abdominal pain as the main complaint.We selected the samples according to the below criteria: 1.Children age: 2-year old to 14-year old;2.Abdominal pain as the main complaint;3.Course of disease less than three months;4.Children can express by themselves on the subjective symptoms;5.Traumatic abdominal pain was eliminated.Methods: Based on the interrogation principle of children with acute or paroxysmal abdominal pain as well as the previous etiological classification such as six-step diagnosis principle proposed by Boyle and nine-group etiology classification proposed by Ji Hoi Kim,in this study we categorized children with acute or paroxysmal abdominal pain into five groups.Group 1 catastrophic abdomen(including life-threatening surgical and medical diseases,such as acute appendicitis complicated peritonitis,acute severe pancreatitis,etc.);Group 2 surgical and internal medicine related acute abdomen diseases including the disease for stomach,intestines,liver,gallbladder,pancreas,genitourinary system,etc.),all the organic diseases excluded from the first group;Group 3 viral or bacterial infection;Group 4 functional gastrointestinal disorder with acute manifestation;Group 5 fecal retention or defecation difficulties.We regroup the patients with final clinical diagnosis into five group classification,and calculate on the composition of these cases as well as the characters of symptom then compared in disease incidence and related clinical characteristics,including average age,sex ratio,average duration and incidence of common clinical symptoms,laboratory examination results.And finally make the analysis of misdiagnosis rate.Results:There were 45 etiologies in all of the 814 children with acute or paroxysmal abdominal pain in this study.Utilization of the five group classification,the results were as follows:1.Demography: There were 128(15.72%)cases aged 2-3 years old as the infant subgroup,291(35.75%)cases aged 4-6 years old as the preschool subgroup,395(48.53%)cases aged 7-14 years old as the school age subgroup.Average age was 8.02±3.21 years old,7.42±3.13 years old,5.53±2.49 years old,8.15±3.88 years old and 6.31±3.07 years old respectively for Group 1,Group 2,Group 3,Group 4 and Group 5.Compared with the other groups,it's significantly younger in Group 3 and Group 5(P<0.05).2.For the detailed cause of composition in different group: There were 73(8.97%)cases in Group 1 with 38.35%(28 cases)of acute appendicitis complicated peritonitis as the most common cause.There were 546(67.08%)cases in Group 2 with the most common diseases of Henoch-Sch?nlein purpura(173 cases,31.68%),acute appendicitis(166 cases,30.40%)and acute gastroenteritis(65 cases,11.90%).There were 71(8.72%)cases in Group 3,containing 91.55%(65 cases)acute upper respiratory tract infection.In Group 4,the most common disease is gastrointestinal dysfunction(16 cases,84.21%)in total 19 cases(2.33%).There were 105 cases(12.90%)in Group 5.3.The clinical features of 5 groups:(1)The average duration: it's 2.42 ± 2.00 days,5.24 ± 8.93 days,5.17±9.06 days,12.84±12.91 days,10.51±13.96 days,respectively in Group 1-5.The average duration for Group 1-3 was shorter than the one in Group 4 and 5.The difference is significant(P< 0.05).(2)Clinical symptoms: there were no difference among the incidence of symptoms such as fever and vomiting in the five groups(P>0.05).Diarrhea was shown up in Group 1,2 and 4,but still there was no significant difference between the groups(P>0.05).(3)Laboratory test results: total white blood cells,the percentage of neutrophils,C reactive protein in Group 1 was significantly higher than the other four groups(P<0.05),compared with other four groups the value of C reactive protein in Group 2 was significant high(P<0.05),but the average value was lower than the one in Group 1.92.82%(181 cases)of patients had abdominal pain relief after providing the enema to Group 3,4 and 5.4.The cause of abdominal pain in different age groups: in Group 1,containing infant subgroup,preschool subgroup and school age subgroup,the most common cause was appendicitis complicated peritonitis,with 2.34%(3 cases),3.78%(11 cases),3.55%(14 cases)respectively.In Group 2,children were with acute gastroenteritis(27 cases,21.88%),acute appendicitis(15 cases,11.72%)and Henoch-Sch?nlein purpura(12 cases,9.38%);the preschool subgroup for Henoch-Sch?nlein purpura was 28.18%(82 cases),and the acute appendicitis was 18.56%(54 cases)and acute gastroenteritis was 8.59%(25 cases);the school age subgroup for acute appendicitis was taking 24.62%(97 cases),Henoch-Sch?nlein purpura 20.05%(79 cases)and peptic ulcer and gastric and duodenal inflammation taking 9.64%(38 cases).In Group 3,the upper respiratory infection was common in subgroups with 11.72%(15 cases)infant subgroup,10.65%(31 cases)in preschool subgroup and 4.82%(19 cases)in school age subgroup.In Group 4,it's all about gastrointestinal dysfunction.The proportion of their respective age subgroups were: 3.13%(4 cases)in infant subgroup,0.69%(2 cases)in preschool subgroup and 2.54%(10 cases)in school age subgroup.In Group 5,fecal retention or defecation difficulties,there were 25(19.53%)cases in infant subgroup,41(14.09%)cases in preschool subgroup and 39(9.90%)cases in school age subgroup.5.The misdiagnosis rate: the misdiagnosis rate of hospitalized cases was 4.55%(32 cases),the Group 1 of "catastrophic abdomen" was with the highest misdiagnosis rate 8.22%(6 cases).The second one is Group 3 with a total of 3(7.89%)cases.Conclusion:1.The new classification system to classify causes of the acute or paroxysmal of abdominal pain is very important on optimize the diagnosis flow and making the early right decision on the treatment.2.The average age difference could help on the correct diagnosis in all causes of children with acute or paroxysmal abdominal pain.3.Organic diseases were mainly distributed in Group 1 and Group 2.The most common cause of catastrophic abdomen is acute appendicitis complicated peritonitis.The most common causes of organic diseases in Group 2 were acute appendicitis,Henoch-Sch?nlein purpura and acute gastroenteritis.The common dysfunctional diseases were distributed in Group 3,Group 4 and Group 5.And the most common cause of each group was acute upper respiratory tract infection,gastrointestinal dysfunction and fecal retention.Children in younger ages are more likely to have acute functional abdominal pain.4.White blood cell count,percentage of neutrophils and C-reactive protein increased significantly for the reference of catastrophic abdomen.5.The enema was effective in Group 3,4 and 5.6.The traditional diagnostic system may mislead diagnosis,and the misdiagnosis rate of “catastrophic abdomen” is 8.22%,which can lead to serious consequence.7.Compared with the previous literatures,mentioned classification diagnosis system of children with acute or paroxysmal abdominal pain,five group classification helps to simplify the diagnostic process,early detection of catastrophic abdomen,identify the cause of abdominal pain,reduce or avoid misdiagnosis,which has better clinical application value. |
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