Audit of Checklist in Recurrent Abdominal Pain

Background: Recurrent abdominal pain (RAP) is common at 30% in childhood especially females 4-6 years of age and 9-11 years. RAP is more commonly non-organic i.e. functional abdominal pain FAP. A symptom-based approach is usually used by clinicians to identify the red flag symptoms of organic disease. In a previous retrospective study in 2015, co-author Dace studied 41 patients with RAP. 63% had investigation but had no red flag symptoms.

A checklist with sub-typing (attached) was developed to be used by the same doctor at every consult for FAP.

Objective: Reduce unnecessary investigations, keep approach consistent and subtype the FAP.

Methods: A retrospective cross-sectional design was used by Hana in this audit. If FAP is diagnosed the subtype is filled out. The treatment plan signed by parents is filed.

Results: Hana found a total of 23 (n=23) new patients with recurrent abdominal pain who had the checklist filled. One case (4.3%) had investigations in the absence of red flag symptoms. Six cases (26%) reported no red flag symptoms and did not undergo any investigation. Sixteen of the twenty-three cases (70%) reported at least one red flag symptom and received agreed investigations.

3 of the 23 children had organic causes (Gastritis, reflux and Crohns). The subtypes of FAP we identified were 5% (1) functional dyspepsia (upper abdomen discomfort), 50% (10) irritable bowel (FAP with alteration in stool consistency), 5% (1) abdominal migraine (history of maternal migraine and child has paroxysmal episodes of FAP with associated anorexia, pallor, nausea) and 20% (4) Functional abdominal pain syndrome (by exclusion).

Conclusion: This audit illustrates a significant reduction (63% to 4.3%) in the frequency of unnecessary investigations performed in the absence of red flag symptoms following the introduction of the checklist. Irritable bowel functional abdominal pain is commonest subtype. We recommend this method.