title: The utility of the emergency department observation unit for children with abdominal pain.
abstract: OBJECTIVE
  This study aimed to determine the outcome of children with unclear etiology for acute abdominal pain admitted to the emergency department observation unit (EDOU).
  
  
  METHODS
  This is a retrospective cohort study of children 18 years or younger who presented with acute abdominal pain to a tertiary pediatric ED and were observed in the EDOU. Children with alternative explanations for abdominal pain were excluded. Patients were classified based on disposition, and data were analyzed using χ tests.
  
  
  RESULTS
  There were 237 patients included in the study (median age, 9 years; 46% male). Mean length of stay in EDOU was 14.4 hours. Fifty-four percent were evaluated by surgery. Two hundred (84%) were discharged; 37 (16%) were admitted, of whom 22 (9%) underwent surgical intervention (13 appendectomies, 6 ovarian cystectomies, 2 small-bowel obstructions, 1 cholecystectomy). Eight had acute appendicitis on pathology reports. The duration of symptoms, the presence of fever, nausea/vomiting, right-lower-quadrant pain, rebound tenderness, or leukocytosis greater than 10,000 cells/μL did not predict admission. Patients with diarrhea were more likely to be discharged home (P = 0.02). Intravenous hydration (86%) and pain control (63%) were the most common interventions in the EDOU. Abdominal pain not otherwise specified and acute gastroenteritis were the 2 most common discharge diagnoses. Eight (4%) of the 200 discharged patients returned to the ED within 48 hours, and all were discharged home from the ED.
  
  
  CONCLUSIONS
  The majority of children admitted to the EDOU with abdominal pain have nonsurgical causes of abdominal pain. The EDOU provides a reasonable alternative for monitoring these patients pending disposition.
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA. wai@bcm.edu
authors.forename: Shannon
authors.initials: S
authors.lastname: Wai
authors.forename: Long
authors.initials: L
authors.lastname: Ma
authors.forename: Eugene
authors.initials: E
authors.lastname: Kim
authors.forename: Aderonke
authors.initials: A
authors.lastname: Adekunle-Ojo
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology; D000293:Adolescent; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005440:Fluid Therapy; D005759:Gastroenteritis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D010048:Ovarian Cysts / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D059408:Pain Management; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D063189:Symptom Assessment; D057832:Watchful Waiting / Q000458:organization & administration* / Q000706:statistics & numerical data