Il dolore addominale acuto nel bambino: un problema internistico da riconsiderare

A prospective study was conducted for a 10 month period on a population of 58,000 inhabitants less than 15 years of age, to estimate the raw and specific incidences of acute abdominal pain as well as to verify the accuracy and diagnostic concordance of hospital and referring physicians. The diagnosis of both groups were related to a gold standard obtained either after 15 days of the inital episode in the ambulatory patients, or at discharge in those requiring hospitalization.The estimated annual raw rate fro arrival to the Emergency Department for acute abdominal pain in 18.8% for children 0-14 years of age, with a first peak at year 1 and a second one between 4 and 5 years of age. The incidence of surgical sickness is 1.6 per 1000 children per yaer, accounting for about 9% of all admissions for acute abdominal pain. The functional forms constitute more than 60% of total cases. The only symptoms that correlate with the surgical diagnosis are the long duration and greater intensity of pain. Almost 70% of arrivals to the Emergency Department is direct and the incidence of admittance is related to the socio-economic level of the families. It is higher in cases with good income and is generally mediated by a physcoan in cases where the head of household has a high level of education. In such cases there is a more scrupolous surgical diagnosis which, on the contrary, is partly underestimated in cases of families with low income and education level. Generally, the surgical diagnosis is highly overestimated by the community physician, making up 74% of all referrals. The accuracy of diagnosis is 33% for the community physicians while it is 81% for the emergency physicians. The agreement K between the referring and emergency physicians is 6%, while the concordance between the first diagnosis of emergency hysicians and the diagnosis after confirmation is 81%. If the referring physician is a pediatrician the former seems to rise while in the second seems to diminish slightly. The factors that greatly influence the trend to diagnose surgical problems seem to be: 1) the socio-economic level of the family; 2) the previous diagnosis formulated by the pediatrician; 3) the promptness of referral to the Emergncy Department. The general attitude of considering acute abdominal pain as a surgical problems desires to be changed.