Systematic review of diagnostic pathways for patients presenting with acute abdominal pain

Burlet, Kirsten J. de; Ing, Andrew; Larsen, Peter; Dennett, Elizabeth

doi:10.1093/intqhc/mzy079

Cited by 11 publications

(7 citation statements)

References 30 publications

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Section: Discussionmentioning

confidence: 99%

“…We found that children with a behavioral health diagnosis had a shorter time to PSG, perhaps reflecting greater physician or caregiver motivation to pursue diagnosis and treatment in these children. 36,37 When compared with White and Hispanic children, Black children more often had medical management recommended by the surgeon. Black children were also more likely to already use intranasal corticosteroids or leukotriene receptor antagonists.…”

Section: Discussionmentioning

confidence: 99%

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Sociodemographic Differences in Care Plans and Time to Treatment Among Children Being Considered for Adenotonsillectomy

Knaus

Koppera

Lind

et al. 2021

Otolaryngol.--head neck surg.

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Objective To assess sociodemographic differences in care plans and time to evaluation or treatment after otolaryngologic consultation among children with obstructive sleep-disordered breathing (oSDB). Study Design Retrospective cohort study. Setting Single tertiary children’s hospital. Methods We included children aged 2 to 9 years with oSDB seen from June to December 2018 as new otolaryngology clinic patients. Logistic regression was used to examine whether sociodemographic factors were associated with having adenotonsillectomy or polysomnography planned at the end of the visit. Kaplan-Meier analyses and Cox proportional hazards models were used to compare times to these events. Results An overall 1020 children were included, of whom 65% were White and 18% were Black. Approximately 77% were metropolitan residents, 52% were publicly insured, and 88% of caregivers spoke primarily English. Treatment plans included adenotonsillectomy for 62% of patients, polysomnography for 15%, and new medication therapy for 13%. In multivariable analyses, there were no significant differences by child race/ethnicity, metropolitan/nonmetropolitan residence, type of health insurance, or caregiver primary language in the likelihood of having adenotonsillectomy or polysomnography planned. Among children for whom adenotonsillectomy was planned, children from metropolitan areas had greater times to surgery than children from nonmetropolitan areas (hazard ratio, 0.81 [95% CI, 0.66-0.99]; P = .04). This was explained by a difference between Black children from metropolitan areas and White children from nonmetropolitan areas (hazard ratio, 0.65 [95% CI, 0.49-0.86]; P = .003); there were no racial/ethnic differences in time to surgery among metropolitan-residing children ( P = .09). Conclusions After initial otolaryngology consultation, children with oSDB from metropolitan areas have longer times to adenotonsillectomy than those from nonmetropolitan areas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sociodemographic Differences in Care Plans and Time to Treatment Among Children Being Considered for Adenotonsillectomy

Knaus

Koppera

Lind

et al. 2021

Otolaryngol.--head neck surg.

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show abstract

“…Hier wird nahezu einvernehmlich geraten, dass im Zweifel diese Untersuchung durchgeführt werden soll. Somit zeigt sich, wie in der vorliegenden Untersuchung auch festgestellt, ein Anstieg der vorgenommenen CT-Untersuchungen [9][10][11][12].…”

Section: Literaturvergleichunclassified

Consultations by senior physicians in general and abdominal surgery for other medical disciplines over 10 years at a tertiary center—Is a fast time-consuming processing necessary?

et al. 2023

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Zusammenfassung Hintergrund Die Herausforderungen einer adäquaten, effizienten und rationellen medizinischen Versorgung und Betreuung von Patienten stehen immer im Zusammenhang mit der interprofessionellen Tätigkeit mehrerer Fachdisziplinen. Ziel Die Breite variabler Diagnosen und des Profils der chirurgischen Entscheidungsfindung mit weiterführenden chirurgischen Maßnahmen im Rahmen des allgemein- und viszeralchirurgischen Oberarztkonsils für medizinische Nachbardisziplinen wurde über einen definierten Beobachtungszeitraum an einer repräsentativen Patientenklientel analysiert. Patienten und Methode Über 10 Jahre (01.10.2006 bis 30.09.2016) wurden alle konsekutiven Patienten (n = 549 Fälle) im Rahmen einer klinisch-systematischen, prospektiven unizentrischen Observationsstudie an einem tertiären Zentrum in einer computerbasierten Patientendatei erfasst und hinsichtlich klinischem Befund‑, Diagnose- und therapeutischem Entscheidungsspektrum und ihrer signifikanten Einflussfaktoren sowie Geschlechts- und Altersunterschied als auch hinsichtlich zeitabhängiger Entwicklungstrends mittels χ2-Test und U-Test analysiert. Ergebnisse (Eckpunkte) Die dominierende Fachdisziplin der Konsilabforderung war die Kardiologie (19,9 %), gefolgt von anderen chirurgischen Fächern (11,8 %) und der Gastroenterologie (11,3 %). Das Diagnoseprofil wurde von Wundheilungsstörungen (7,1 %) und akutem Abdomen (7,1 %) bestimmt. Bei 11,7 % der Patienten wurde die unmittelbare Operationsindikation gestellt und bei 12,9 % wurde die Operation elektiv empfohlen. Die Übereinstimmungsrate von Verdachts- und definitiver Diagnose lag bei lediglich 58,4 %. Schlussfolgerung Die chirurgische Konsiltätigkeit ist ein wichtiges Standbein für die suffiziente und vor allem zeitgerechte Klärung chirurgisch relevanter Fragestellungen in fast jeder medizinischen Einrichtung, so vor allem auch in einem Zentrum. Sie dient i) der chirurgischen Qualitätssicherung bei der klinischen Mitbetreuung von Patienten mit interdisziplinärem, hier chirurgischem Versorgungsbedarf in der täglichen allgemein-/viszeralchirurgischen Praxis im Rahmen der klinischen Versorgungsforschung; ii) dem Klinikmarketing sowie monetären Aspekten im Sinne von Patientenrekrutierung (und) iii) nicht zuletzt der Notfallversorgung von Patienten. Aufgrund des hohen Anteils von 12 % folgenden Notfalloperationen nach gestellter allgemein-/viszeralchirurgischer Konsilanforderung sind diese zeitnah in der Dienstzeit abzuarbeiten.

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“…Острая боль в животе у детей (ОБЖД) представляет серьезную проблему для врачей как первичного звена, так и специализированных отделений. Она определяется как острая боль нетравматического происхождения, длительностью до 5-7 суток, требует качественной диагностики, быстрого лечения, в ряде случаев -срочного хирургического вмешательства [1,2,3,4].…”

Section: Introductionunclassified

Clinical Significance of Polymorphonuclear Neutrophils in the Stratification of Children With Acute Abdominal Pain

Вакульчик¹,

Khudovtsova²

2022

Journal GrGMU

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Background. Acute abdominal pain in children is defined as acute pain of non-traumatic genesis lasting up to 5-7 days, and presents a serious diagnostic and tactical problem. Many aspects of diagnosis and treatment remain controversial. Aim. To determine the clinical significance of polymorphonuclear neutrophil count in the stratification of children with acute abdominal pain. Material and Methods. A prospective randomized blind clinical trial was performed. The results of examination and treatment of 633 children admitted to Grodno Regional Children's Clinical Hospital with acute abdominal pain were analyzed. The number of polymorphonuclear neutrophils was analyzed in relative (PNRV) and absolute (PNAV) values. Statistics included evidence-based criteria, ROC and precision-recall curve analysis, Kullback's measure of informativeness (Jxi), Bayes' theorem. Results. Separation points were determined for the PNRV and PNAV tests. It was 65% for the PNRV test and 8.952×109/L for the PNAV test. For PNRV values less than 65%, the probability of acute appendicitis (AA) as a cause of acute abdominal pain was 1.8% (CI 0.2 to 3.4); the overall informative value was 2.94. With PNAV test values less than 6.5×109/L, the probability of AA was 1.2% (CI 0.03 to 2.4%); the overall informative value was 5.24. It was demonstrated that an increase in test values above the indicated values did not significantly increase the probability of AA as a cause of acute abdominal pain in children. Conclusion. The tests studied are highly informative and can be used to stratify patients with acute abdominal pain. It is necessary to validate the results obtained taking into account the specific capabilities of a given medical institution and the type of equipment used.

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Systematic review of diagnostic pathways for patients presenting with acute abdominal pain

Cited by 11 publications

References 30 publications

Sociodemographic Differences in Care Plans and Time to Treatment Among Children Being Considered for Adenotonsillectomy

Sociodemographic Differences in Care Plans and Time to Treatment Among Children Being Considered for Adenotonsillectomy

Consultations by senior physicians in general and abdominal surgery for other medical disciplines over 10 years at a tertiary center—Is a fast time-consuming processing necessary?

Clinical Significance of Polymorphonuclear Neutrophils in the Stratification of Children With Acute Abdominal Pain

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