Veenstra, L.M.M. (2018) Diagnostic process of children with acute abdominal pain in general practice : Involuntary guarding and tenderness in the right lower quadrant arestrongest diagnostic factors for appendicitis’. thesis, Medicine.
Full text available on request.Abstract
Introduction Acute abdominal pain in children is a common complaint in general practice. The general practitioner (GP) is faced with the challenge to make a referral or safely rule out a life-treating diagnosis as appendicitis by himself. Information on the diagnostic process of children with acute abdominal pain and the resulting diagnostic factors for appendicitis, can provide insight and guidance in this diagnostic dilemma. Methods This is a retrospective cohort study with a follow-up period of six weeks. Symptoms, signs and additional tests were collected from consultations of children visiting the GP with acute abdominal pain. As reference standard for appendicitis, we used the specialist letter combined with the documentation of appendicitis in the patient file during the follow-up period. Diagnostic factors were assessed on ruling in and ruling out appendicitis and we examined their association with appendicitis. Results In total 5692 children were included, of which 295 (5.2%) with appendicitis. Duration of pain and involuntary guarding were most often described by the GP. In addition, 160 imaging tests were requested and the GP performed a C-reactive protein (CRP) test in 598 (10.5%) children. Tenderness in the right lower quadrant (RLQ) had the highest negative Likelihood Ratio (LR) (0.08 (0.05-0.15)) and involuntary guarding had the highest positive LR (12.73 (9.66-16.76)). Finally, 31.2% of 945 (16.6%) referred children had appendicitis. Discussion A limitation of registration data is that not all data is documented in a structured way, but it has the advantage of ‘real-world evidence’. Conclusion In conclusion, the absence of RLQ tenderness could help the GP to rule out appendicitis and the presence of involuntary guarding increases the probability of appendicitis. A more structured evaluation and guidance in primary care is needed to refer children with acute abdominal pain more adequately
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Holtman, Dr. G.A. and Blok, Drs. C.G.H. and Berger, Prof. Dr. M.Y. and Department of General Practice and University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/145 |
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