Using quantitative methods to improve the diagnostic workup for abdominal pain in children.
BACKGROUND
The differential diagnosis of abdominal pain in children can be challenging. We applied quantitative decision-making methods to this process and sought to determine if their use provided measurable benefit.


METHODS
After obtaining institutional review board approval, we recorded key elements of the history, physical examination, laboratory, and imaging evaluations along with the cost and the time spent in the emergency department (ED) for children presenting with abdominal pain. Initially, data were collected (group 1, n = 1366 patients) and then presented to the ED pediatricians. For subsequent patients, ED physicians received a sheet specific to that patient's age and sex reporting the most common diagnoses and the elements of the evaluation that had proven most useful (group 2, n = 624 patients). We compared the difference in length of stay and costs before and after intervention, between study groups, by age groups, and separately by sex using a 2-factor analysis of variance.


RESULTS
The diagnostic workup cost less in boys aged 2 to 12 years after the intervention. In boys and girls older than 12 years, the cost trended lower.


CONCLUSIONS
This study demonstrates that ED physicians equipped with specific information were able to complete their diagnostic evaluation of children presenting with abdominal pain at a lower cost.
Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
David A
DA
Lanning
Ronald L
RL
Thomas
Kim D
KD
Rood
Michael D
MD
Klein
D015746:Abdominal Pain / Q000209:etiology*; D017677:Age Distribution; D001064:Appendicitis / Q000175:diagnosis / Q000453:epidemiology; D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D019937:Diagnostic Techniques and Procedures / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies