Spee Leo A A, Lisman-van Leeuwen Yvonne, Benninga Marc A, Bierma-Zeinstra Sita M A, Kollen Boudewijn J, Berger Marjolein Y
Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Ann Fam Med. 2015 Mar;13(2):158-63. doi: 10.1370/afm.1736.
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.
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.
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.
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.
腹痛是儿童常见症状，但很少与器质性疾病相关。尽管腹痛可能持续数年，但尚未发现可预测其预后的因素。我们的目的是确定初诊时的患者特征是否能够预测慢性腹痛严重到足以在随访1年时影响儿童的健康状况。
我们在初级保健机构开展了这项前瞻性队列研究，纳入家庭医生诊治的连续4至17岁因腹痛就诊的儿童。采用多因素逻辑回归分析确定预测1年后慢性腹痛的预后因素。使用受试者工作特征曲线下面积和解释方差评估已确定预测因素的判别能力。
在整个队列中，随访1年时发生慢性腹痛的风险为37.1%。年龄增长、夜间因疼痛醒来、其他躯体症状水平高以及基线时的慢性腹痛可独立预测1年后的慢性腹痛。然而，这些预测因素的判别能力较差至中等；受试者工作特征曲线下面积仅为0.69，这些预测因素共同仅解释了慢性腹痛发生方差的14.3%。绝对风险范围从无任何预测因素的儿童中的19.4%到有3个或4个预测因素的儿童中的65.5%。
对于因腹痛首次就诊于家庭医生的儿童，足以影响健康的慢性腹痛很常见。尽管这种结果的风险随预测因素数量增加而升高，但这些预测因素在识别疼痛将转为慢性的儿童方面价值有限，这表明其他尚未明确的因素起着重要作用。
