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K Pituch

Publications and source records attributed to K Pituch.

6 recordsLinked to original sources
PubMed1998

Use of the rectal examination on children with acute abdominal pain.

The purpose of this study was to determine the frequency with which general pediatricians perform a rectal examination on children with a complaint of acute abdominal pain and to determine factors associated with performing a rectal examination. Children were eligible for the study if they were 2 to 12 years of age and presented to the clinic or emergency department of a municipal teaching hospital with a complaint of abdominal pain of less than or equal to three days' duration. Measured variables included demographic characteristics and presenting signs and symptoms. For each patient, a clinical reviewer (1) assigned a final diagnosis, (2) determined whether a rectal examination had been performed, and (3) assessed the clinical contribution of the rectal examination findings. For 1,140 children presenting for a nonscheduled visit with acute abdominal pain, a rectal examination was performed on 4.9% (56/1,140). Using multiple logistic regression, children were more likely to have a rectal examination performed if they had abdominal tenderness (odds ratio [OR] = 3.3 and 95% confidence interval [CI], 1.8 to 6.0), a history of constipation (OR = 6.0 and 95% CI, 2.3 to 15.3), or a history of rectal bleeding (OR = 9.1 and 95% CI, 2.9 to 29). Children were less likely to have had a rectal examination performed if they presented with associated symptoms of cough (OR = 0.32 and 95% CI, 0.14 to 0.74), headache (OR = 0.15 and 95% CI, 0.05 to 0.46), or sore throat (OR = 0.28 and 95% CI, 0.08 to 0.91). The final diagnoses of 12 children who had clinically contributory findings on rectal examination included: constipation (5), gastroenteritis (3), appendicitis (2), abdominal adhesions (1), and abdominal pain of unclear etiology (1). General pediatricians infrequently perform a rectal examination on children who present with a complaint of acute abdominal pain. Clinical factors affect the likelihood of whether a rectal examination is performed.

Abdomen, Acute↗
PubMed1996

Effect of health care system factors on test ordering.

OBJECTIVE: To determine the effect of the emergency department (ED) environment and other health care system factors on test ordering for children with acute abdominal pain. METHODS: We reviewed the encounter records of 1140 consecutive children seen in either the pediatric clinic or ED of an inner-city teaching hospital with a complaint of acute abdominal pain (< 72 hours). In the ED and the clinic, patients were seen by medical students, pediatric residents, and general pediatric faculty members. Measured data on test ordering included the number of tests ordered and the type of tests ordered; specifically examined were the throat culture, urinalysis or urine culture, and chest radiograph. Measured health care system factors included (1) encounter location; (2) resident involvement and level of training; (3) student involvement; and (4) faculty member's years of experience and sex. RESULTS: Of the 1140 children, 117 (10.2%) were seen in the ED, 531 (47.1%) were seen by a resident, 344 (30.2%) were seen by a medical student, and 195 (17.1%) were seen by a faculty member with more than 10 years of clinical pediatric experience. After controlling for initial signs and symptoms in multiple logistic regression, a child treated in the ED was no more likely to have had tests ordered than one who was treated in the clinic. Neither resident involvement nor resident training level affected test ordering. Except for decreasing the likelihood of having a urinalysis or urine culture ordered (odds ratio [OR] = 0.30; 95% confidence interval [CI], 0.15-0.63), student involvement did not affect test ordering. Also, except for decreasing the likelihood of having a throat culture ordered (OR = 0.45; 95% CI, 0.25-0.83), being seen by a pediatrician with more than 10 years of experience did not affect test ordering. Children seen by female physicians were more likely (OR = 2.41; 95% CI, 1.57-3.70) to have at least 1 test ordered. CONCLUSIONS: For children seen for a complaint of acute abdominal pain, we found little evidence that test ordering is affected by encounter location, resident involvement, student involvement, or faculty member experience.

Abdomen, Acute↗
PubMed1996

Clinical outcomes of children with acute abdominal pain.

OBJECTIVE: To determine the prevalence, associated symptoms, and clinical outcomes of children presenting for a nonscheduled visit with acute abdominal pain. DESIGN: Historical cohort. SETTING: Inner-city teaching hospital. PARTICIPANTS: A total of 1141 consecutive children, ages 2 to 12, presenting for a nonscheduled visit (clinic or emergency department) with a complaint of nontraumatic abdominal pain of < or = 3 days' duration were identified through a manual chart review. MEASUREMENTS: Collected data included: 1) demographic characteristics, 2) presenting signs and symptoms, 3) records from the hospital record for all children who returned within 10 days for follow-up, 4) test results, and 5) telephone follow-up. A clinical reviewer used the data to assign a final diagnosis to each patient. RESULTS: The prevalence of children presenting with abdominal pain of < or = 3 days' duration was 5.1%. The most common associated symptoms were history of fever (64%), emesis (42.4%), decreased appetite (36.5%), cough (35.6%), headache (29.5%), and sore throat (27.0%). The six most prevalent final diagnoses, accounting for 84% of all final diagnoses, were upper respiratory infection and/or otitis (18.6%), pharyngitis (16.6%), viral syndrome (16.0%), abdominal pain of uncertain etiology (15.6%), gastroenteritis (10.9%), and acute febrile illness (7.8%). Approximately 1% of children required surgical intervention (10/12 for appendicitis). Approximately 7% of children returned within 10 days for reevaluation of their illness; on return, 11 had treatable medical diseases and 4 had diseases requiring surgical intervention. CONCLUSIONS: An acute complaint of abdominal pain in children occurs in 5.1% of nonscheduled visits, is frequently accompanied by multiple complaints, and is usually attributed to a self-limited disease. Close follow-up will identify the 1% to 2% who proceed to have a more serious disease process. This epidemiologic data will aid clinic-based physicians who manage children with acute abdominal pain.

Abdominal Pain↗