Predictors of chronic abdominal pain affecting the well-being of children in primary care.
PURPOSE
Abdominal pain is a frequent symptom among children but is rarely associated with organic disease. Although it may persist for years, no factors have been identified that predict its prognosis. Our aim was to determine whether patient characteristics at initial consultation can predict chronic abdominal pain severe enough to influence the child's well-being at 1 year of follow-up.


METHODS
We conducted this prospective cohort study in primary care, including consecutive children aged 4 to 17 years seen for abdominal pain by their family physician. Multivariate logistic regression analysis was used to identify prognostic factors that predicted chronic abdominal pain 1 year later. Discriminative ability of identified predictors was assessed using the area under the receiver operating characteristic curve and explained variance.


RESULTS
The risk of having chronic abdominal pain at 1 year of follow-up was 37.1% in the cohort overall. Increasing age, waking up at night with pain, high levels of other somatic complaints, and chronic abdominal pain at baseline independently predicted chronic abdominal pain at 1 year. These predictors had a poor to moderate discriminative ability, however; the area under the receiver operating characteristic curve was only 0.69, and the predictors collectively explained only 14.3% of variance in the development of chronic abdominal pain. The absolute risk ranged from 19.4% among children having none of the predictors to 65.5% among children having 3 or 4 predictors.


CONCLUSIONS
Chronic abdominal pain sufficient to affect well-being is common among children initially seen for abdominal pain by family physicians. Although the risk of this outcome increases with number of predictors, these predictors are of limited value in identifying children in whom pain will become chronic, suggesting that other, as yet unidentified factors play an important role.
['Spee|Leo A A|LA|', 'Lisman-van Leeuwen|Yvonne|Y|', 'Benninga|Marc A|MA|', 'Bierma-Zeinstra|Sita M A|SM|', 'Kollen|Boudewijn J|BJ|', 'Berger|Marjolein Y|MY|']
D015746:Abdominal Pain D000293:Adolescent D000367:Age Factors D019540:Area Under Curve D002648:Child D002675:Child, Preschool D002908:Chronic Disease D015331:Cohort Studies D005194:Family Practice D005260:Female D006304:Health Status D006801:Humans D016015:Logistic Models D008137:Longitudinal Studies D008297:Male D015999:Multivariate Analysis D009426:Netherlands D011320:Primary Health Care D011446:Prospective Studies D012372:ROC Curve D012307:Risk Factors D012737:Sex Factors D018582:Sick Leave
abdominal pain prognosis child gastrointestinal diseases practice-based research primary health care