Çocuk acil servisine akut karın ağrısı nedeni ile başvuran hastalarda klinik önemli abdominal patolojiyi belirleyen faktörlerin prospektif olarak incelenmesi

Abstract

DAŞLI, E. Evaluation of factors determining clinically significant abdominal pathology in patients presenting to the pediatric emergency department with acute abdominal pain. Hacettepe University Faculty of Medicine, Department of Child Health and Diseases,Thesis in Pediatrics, Ankara, 2024. Acute abdominal pain is among the most common reasons for emergency department visits in children and is diagnostically challenging for physicians. This study aimed to evaluate the clinical and demographic characteristics of patients who applied to the pediatric emergency department due to abdominal pain and to determine the factors associated with clinically significant abdominal pathology (CSAP). The primary outcome of the study was to determine the clinical factors indicating CSAP in patients presenting to the pediatric emergency department with acute abdominal pain; The secondary outcome is to determine the frequency of readmission among patients with non-spesific abdominal pain (NSAP), its causes, and the criteria indicating CSAP among these patients. In this prospective cross-sectional study, all patients who applied to the Pediatric Emergency Department of our hospital with complaints of abdominal pain between February 1, 2023 and July 31, 2023 were included in the study. Demographic characteristics, clinical history and physical examination findings, laboratory results and radiological imaging of 1738 patients included in the study were taken from electronic medical records. The patients were called by phone on the third and seventh days to complete the follow-up process. All data were analyzed separately for the patients with NSAP and the patient groups with CSAP-Medical and CSAP-Surgery, and the results were compared with each other. In our study, it was determined that 85% of the patients presenting with abdominal pain had a direct abdominal radiography. It is significant that patients diagnosed with CSAP are more likely to call 112, have been admitted to another center within the last 72 hours before applying to our hospital, have a history of more surgical operations, and have complaints of vomiting along with abdominal pain, organomegaly, and gradually increasing or not decreasing abdominal pain. was seen. In conclusion; patients with NSAP are frequently seen in patients presenting to the pediatric emergency clinic with abdominal pain, and the frequency of using abdominal radiography is higher than expected, patients who applied with transported by ambulance, who were admitted to another hospital within the last 72 hours before admission to the hospital, whose abdominal pain gradually increased or whose pain intensity did not change, who had a history of previous surgery related to the gastrointestinal system, who had tachypnea, and who were monitored for more than 6 hours in the pediatric emergency department, should be diagnosed with CSAP. The probability was found to be high it was observed that patients who had a history of surgery related to surgery, had tachypnea, and were monitored for more than 6 hours in the pediatric emergency department were more likely to be diagnosed with CSAP. However, it was understood that these clinical markers were not sufficient to distinguish between CSAP-Medical and CSAP-Surgery. It was determined that the probability of being diagnosed with CSAP in the follow-up of patients with CSAP who were followed up by phone and who presented with a review was low. However, it was thought that the use of markers indicating CSAP would be useful in the follow-up of patients. More studies are needed to investigate clinical markers indicating medical or surgical clinically significant abdominal pathology. It is recommended to create a guide for use in patients presenting with acute abdominal pain.