title: Predictors of chronic abdominal pain affecting the well-being of children in primary care.
abstract: OBJECTIVE
  Abdominal pain is a frequent symptom among children but is rarely associated with organic disease. Although it may persist for years, no factors have been identified that predict its prognosis. Our aim was to determine whether patient characteristics at initial consultation can predict chronic abdominal pain severe enough to influence the child's well-being at 1 year of follow-up.
  
  
  METHODS
  We conducted this prospective cohort study in primary care, including consecutive children aged 4 to 17 years seen for abdominal pain by their family physician. Multivariate logistic regression analysis was used to identify prognostic factors that predicted chronic abdominal pain 1 year later. Discriminative ability of identified predictors was assessed using the area under the receiver operating characteristic curve and explained variance.
  
  
  RESULTS
  The risk of having chronic abdominal pain at 1 year of follow-up was 37.1% in the cohort overall. Increasing age, waking up at night with pain, high levels of other somatic complaints, and chronic abdominal pain at baseline independently predicted chronic abdominal pain at 1 year. These predictors had a poor to moderate discriminative ability, however; the area under the receiver operating characteristic curve was only 0.69, and the predictors collectively explained only 14.3% of variance in the development of chronic abdominal pain. The absolute risk ranged from 19.4% among children having none of the predictors to 65.5% among children having 3 or 4 predictors.
  
  
  CONCLUSIONS
  Chronic abdominal pain sufficient to affect well-being is common among children initially seen for abdominal pain by family physicians. Although the risk of this outcome increases with number of predictors, these predictors are of limited value in identifying children in whom pain will become chronic, suggesting that other, as yet unidentified factors play an important role.
authors.affiliation: Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands l.spee@erasmusmc.nl.
authors.forename: Leo A A
authors.initials: LA
authors.lastname: Spee
authors.affiliation: Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Lisman-van Leeuwen
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.affiliation: Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.affiliation: Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Kollen
authors.affiliation: Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology*; D000293:Adolescent; D000367:Age Factors; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005194:Family Practice; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012737:Sex Factors; D018582:Sick Leave / Q000706:statistics & numerical data*
keywords: abdominal pain; child; gastrointestinal diseases; practice-based research; primary health care; prognosis