# Assessment of Acute Abdominal Pain in Children Presenting to the Emergency Department: A Retrospective Observational Study

## TL;DR

This study examines how children with acute abdominal pain are treated in emergency departments, finding that symptoms like right lower quadrant pain and high white blood cell count may suggest non-surgical issues rather than surgical ones.

## Contribution

The study challenges conventional assumptions by showing that right lower quadrant pain and leukocytosis may indicate non-surgical conditions in children.

## Key findings

- Right lower quadrant pain and leukocytosis were more indicative of non-surgical abdominal conditions in children.
- Leukocytosis and right lower quadrant pain were inversely associated with acute surgical abdomen.
- Right lower quadrant pain and leukocytosis were strongly linked to acute appendicitis among surgical diagnoses.

## Abstract

Objectives: The aim of the study was to assess acute abdominal pain presentation in pediatric patients presenting to the emergency department.

Methods: This is a retrospective study in which data was collected from electronic medical records. Presentations, associated symptoms, findings on physical examination, documented diagnostic tests, and outcomes of patients were collected and examined. Two multivariate analysis models were used to investigate factors associated with acute medical abdomen and acute surgical abdomen.

Results: Out of 2,169 visits during the study period, 235 (10.8%) patients presented with acute abdominal pain. Forty-five (19%) patients had a surgical abdomen, while the remaining had an acute medical abdomen. The most prevalent diagnosis was "non-specific abdominal pain", constituting 61 (26%) patients. Both leukocytosis (OR: 0.15; 95% CI: 0.03-0.51; p = 0.006) and right lower quadrant pain (OR: 0.26; 95% CI: 0.08-0.81; p = 0.021) were inversely associated with an acute surgical abdomen and were more suggestive of an acute medical abdomen. In contrast, right lower quadrant pain (OR: 13.9; 95% CI: 5.03-43.5; p < 0.001), leukocytosis (OR: 3.26; 95% CI: 1.07-11.1; p = 0.045), and neutrophilia (OR: 1.04; 95% CI: 1.01-1.09; p = 0.031) were found to be significantly associated with acute appendicitis.

Conclusion: Pediatric patients' presentations to the emergency department exhibit a diversity of presentations, and diagnostics may be less evident compared to adult patients. Right lower quadrant pain and leukocytosis may be more indicative of a non-surgical abdomen rather than a surgical abdomen among different diagnoses that require surgical intervention. However, right lower quadrant pain and leukocytosis are still strongly associated with acute appendicitis out of different surgical diagnoses. To combine both findings, our conclusion is that right lower quadrant pain and leukocytosis are more predictive of an acute medical abdomen, but only when appendicitis is less likely to be one of the differential diagnoses. These findings challenge conventional clinical paradigms, suggesting that right lower quadrant pain could be a stronger predictor of medical conditions, which typically do not require surgical intervention.