title: Diagnostic outcomes following childhood non-specific abdominal pain: a record-linkage study.
abstract: OBJECTIVE
  Non-specific abdominal pain (NSAP) is the most common diagnosis on discharge following admission for abdominal pain in childhood. Our aim was to determine the risk of subsequent hospital diagnosis of organic and functional gastroenterological conditions following a diagnosis of NSAP, and to assess the persistence of this risk.
  
  
  METHODS
  An NSAP cohort of 268,623 children aged 0-16 years was constructed from linked English Hospital Episode Statistics from 1999 to 2011. The control cohort (1,684,923 children, 0-16 years old) comprised children hospitalised with unrelated conditions. Clinically relevant outcomes were selected and standardised rate ratios were calculated.
  
  
  RESULTS
  From the NSAP cohort, 15,515 (5.8%) were later hospitalised with bowel pathology and 13,301 (5%) with a specific functional disorder. Notably, there was a 4.84 (95% CI 4.45 to 5.27) times greater risk of Crohn's disease following NSAP and a 4.23 (4.13 to 4.33) greater risk of acute appendicitis than in the control cohort. The risk of irritable bowel syndrome (IBS) was 7.22 (6.65 to 7.85) times greater following NSAP. The risks of inflammatory bowel disease (IBD), IBS and functional disorder (unspecified) were significantly increased in all age groups except <2-year-olds. The risk of underlying bowel pathology remained raised up to 10 years after first diagnosis with NSAP.
  
  
  CONCLUSIONS
  Only a small proportion of those with NSAP go on to be hospitalised with underlying bowel pathology. However, their risk is increased even at 10 years after the first hospital admission with NSAP. Diagnostic strategies need to be assessed and refined and active surveillance employed for children with NSAP.
authors.affiliation: Department of Paediatric Gastroenterology, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: G C D
authors.initials: GC
authors.lastname: Thornton
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Goldacre
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Goldacre
authors.affiliation: Department of Paediatric Gastroenterology, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: L J
authors.initials: LJ
authors.lastname: Howarth
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis*; D000293:Adolescent; D000067697:Adolescent Health; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004739:England; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008498:Medical Record Linkage; D018570:Risk Assessment
keywords: Adolescent Health; Evidence Based Medicine; Gastroenterology; General Paediatrics; Paediatric Practice