Tachycardia may prognosticate life- or organ-threatening diseases in children with abdominal pain.
BACKGROUND
Abdominal pain is common in children, but expeditious diagnosis of life- or organ-threatening diseases can be challenging. An evidence-based definition of tachycardia in children was established recently, but its diagnostic utility has not yet been studied.


OBJECTIVE
To test the hypothesis that abdominal pain with tachycardia may pose a higher likelihood of life- or organ-threatening diseases in children.


METHODS
A nested case-control study was conducted in a pediatric emergency department in 2013. Tachycardia was defined as a resting heart rate of more than 3 standard deviations above the average for that age. Life- or organ-threatening diseases were defined as "disorders that might result in permanent morbidity or mortality without appropriate intervention." A triage team recorded vital signs before emergency physicians attended patients. Patients with tachycardia (cases) and without tachycardia (controls) were systematically matched for age, sex, and month of visit. The groups were compared for the presence of life- or organ-threatening diseases.


RESULTS
There were 1683 visits for abdominal pain, 1512 of which had vital signs measured at rest. Eighty-three patients experienced tachycardia, while 1429 did not. Fifty-eight cases and 58 controls were matched. Life- or organ-threatening diseases were more common in the case group (19%) than the control group (5%, p=0.043). The relative risk of tachycardia to the presence of the diseases was 3.7 (95% confidence interval 1.2-12.0).


CONCLUSIONS
Tachycardia significantly increased the likelihood of life- or organ-threatening diseases. Tachycardia in children with abdominal pain should alert emergency physicians to the possibility of serious illness.
Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: itaruhayakawa@gmail.com.
Itaru
I
Hayakawa
Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. Electronic address: hiroshi_sakakibara@tmhp.jp.
Hiroshi
H
Sakakibara
Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. Electronic address: yukari_tsushima@tmhp.jp.
Yukari
Y
Atsumi
Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. Electronic address: hiroshi_hataya@tmhp.jp.
Hiroshi
H
Hataya
Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. Electronic address: toshirou_terakawa@tmhp.jp.
Toshiro
T
Terakawa
D015746:Abdominal Pain / Q000175:diagnosis*; D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007564:Japan; D008297:Male; D013610:Tachycardia / Q000175:diagnosis / Q000453:epidemiology*; D014218:Triage; D055986:Vital Signs
Abdominal pain; Information technology; Organ dysfunction; Pediatrics; Tachycardia; Triage