A diagnostic time-out to improve differential diagnosis in pediatric abdominal pain

Diagnosis ◽  
2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Rena T. Kasick ◽  
Jennifer E. Melvin ◽  
Sajithya T. Perera ◽  
Michael F. Perry ◽  
Joshua D. Black ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Baseline Period ◽  
Post Intervention ◽  
Time Out ◽  
Diagnostic Time ◽  
Thoughtful Reflection ◽  
Medical Teams ◽  
Marginal Improvement ◽  
Scoring Tool

AbstractBackgroundPediatric abdominal pain is challenging to diagnose and often results in unscheduled return visits to the emergency department. External pressures and diagnostic momentum can impair physicians from thoughtful reflection on the differential diagnosis (DDx). We implemented a diagnostic time-out intervention and created a scoring tool to improve the quality and documentation rates of DDx. The specific aim of this quality improvement (QI) project was to increase the frequency of resident and attending physician documentation of DDx in pediatric patients admitted with abdominal pain by 25% over 6 months.MethodsWe reviewed a total of 165 patients admitted to the general pediatrics service at one institution. Sixty-four history and physical (H&P) notes were reviewed during the baseline period, July–December 2017; 101 charts were reviewed post-intervention, January–June 2018. Medical teams were tasked to perform a diagnostic time-out on all patients during the study period. Metrics tracked monthly included percentage of H&Ps with a ‘complete’ DDx and quality scores (Qs) using our Differential Diagnosis Scoring Rubric.ResultsAt baseline, 43 (67%) resident notes and 49 (77%) attending notes documented a ‘complete’ DDx. Post-intervention, 59 (58%) resident notes and 69 (68%) attending notes met this criteria. Mean Qs, pre- to post-intervention, for resident-documented differential diagnoses increased slightly (2.41–2.47, p = 0.73), but attending-documented DDx did not improve (2.85–2.82, p = 0.88).ConclusionsWe demonstrated a marginal improvement in the quality of resident-documented DDx. Expansion of diagnoses considered within a DDx may contribute to higher diagnostic accuracy.

Huge retrovesical hydatid cyst with pelvic localization as the primary site: a case report

2007 ◽  
Vol 48 (8) ◽  
pp. 918-920 ◽  
Author(s):  
A. M. Halefoglu ◽  
A. Yasar
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Hydatid Cyst ◽  
Cystic Mass ◽  
Primary Site ◽  
Cystic Disease ◽  
The World ◽  
Indirect Hemagglutination ◽  
Indirect Hemagglutination Test

We present a patient with symptoms of abdominal pain and frequent urination due to a huge mass in the retrovesical region. All imaging modalities revealed a cystic mass containing small daughter cysts located between the urinary bladder and rectum. Its characteristics led us to suspect the presence of a hydatid cyst, and an indirect hemagglutination test for Echinococcus granulosus was found positive. No other involvement of hydatid cystic disease was detected. The primary site for the hydatid disease was therefore regarded as the pelvis, on which only a few cases have been reported previously. The patient started albendazole therapy, but refused operation. Hydatid cyst should always be considered in the differential diagnosis of abdominopelvic masses in endemic regions of the world.

Irritable Bowel Syndrome with Constipation

2015 ◽  
Author(s):  
Loni Tang ◽  
Brooks D. Cash
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Digital Rectal Examination ◽  
Recurrent Abdominal Pain ◽  
Differential Diagnoses ◽  
Rectal Examination ◽  
Stool Form ◽  
Alarm Features ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain or discomfort that has occurred at least 3 days per month in the 3 months prior to diagnosis. One of the subtypes of this disorder is IBS with constipation (IBS-C), where individuals experience hard or lumpy stools at least 25% of the time and loose or watery stools less than 25% of the time with defecation. This review addresses IBS-C, detailing the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis. A figure shows the Bristol stool form scale. Tables list IBS subtypes, components of digital rectal examination, differential diagnoses for IBS and IBS-C, alarm features, and the American College of Gastroenterology Recommendations. This review contains 1 highly rendered figure, 6 tables, and 71 references. 

Calprotectin (S100 A8/A9) and TNF-alpha in differential diagnosis of chronic abdominal pain in children

2017 ◽  
Vol 53 (1) ◽  
pp. 5-10
Author(s):  
Stanisław Pieczarkowski ◽  
Kinga Kowalska-Duplaga ◽  
Andrzej Wędrychowicz ◽  
Krzysztof Fyderek ◽  
Przemko Kwinta ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Functional Gastrointestinal Disorders ◽  
Fecal Calprotectin ◽  
Chronic Abdominal Pain ◽  
Tnf Alpha ◽  
Gastrointestinal Disorders ◽  
Control Group ◽  
Healthy Children ◽  
Inflammatory Bowel

<i>Introduction:</i> Chronic abdominal pain in children is a very frequent and sometimes challenging diagnostic issue. Differential diagnosis in that cases is difficult and often connected with numerous, time-consuming, expensive, and frequently stressful diagnostic studies. The aim of the study was to establish whether fecal calprotectin concentration (FCC) and TNF-alpha may be useful in children with chronic abdominal pain to differentiate between inflammatory bowel disease (IBD), other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. Methods. The study included patients (median age 13 years), who were assigned to functional gastrointestinal disorders group (n=33); inflammatory gastrointestinal disorders other than IBD (n=71), children with IBD (n=37) and 22 healthy children served as a control group. The concertation of FCC and TNF-alpha in stool samples was measured using ELISA. <i>Results:</i> In healthy children and in children with functional disorders FCCs were below 100 μg/g. In patients with IBD FCCs and TNF-alpha were markedly elevated as compare to children with functional gastrointestinal disorders, however using ROC discrimination of IBD patients was significantly better using FCC than TNF-alpha. <i>Conclusion:</i> FCC is better test for differentiation between IBD, other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders as compare to TNF-alpha concentration in stool. FCC as screening test in patients with chronic abdominal pain should allow to diminish unnecessary diagnostic in cases of functional gastrointestinal disorders.

THE TOS2 STUDY: AN INTERNATIONAL MULTI-CENTRE AUDIT ASSESSING THE STANDARD OF NEUROLOGICAL EXAMINATION

2015 ◽  
Vol 86 (11) ◽  
pp. e4.1-e4 ◽  
Author(s):  
JP Appleton ◽  
A Ilinca ◽  
AG Lindgren ◽  
A Puschmann ◽  
M Habahbeh ◽  
...  
Keyword(s):  
United Arab Emirates ◽  
Educational Intervention ◽  
Neurological Examination ◽  
Post Intervention ◽  
Assessment Score ◽  
Medical Teams ◽  
The Uk

Having previously demonstrated that in-patients referred to neurology at two UK hospitals were not fully examined prior to referral, we designed an audit with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention.In-patients referred to neurology over a 4 month period in the UK, Jordan, Sweden and the United Arab Emirates were asked whether they recalled examination with a Tendon hammer, Ophthalmoscope and Stethoscope since admission. Results were disseminated to local medical teams and data were collected for a further 4 months. Pre and post-intervention data were available for 11 centres with 407 and 391 patients in each arm. 264 patients (64.86%) recalled examination with a tendon hammer pre-intervention, which significantly improved to 298 (76.21%) (p<0.001). 119 (29.24%) recollected ophthalmoscopy pre-intervention, which significantly improved to 149 (38.11%) (p=0.009). 321 (78.87%) recalled examination with a stethoscope pre-intervention, which significantly improved to 330 (84.4%) (p=0.045). Most patients were not fully examined prior to neurology referral, yet a simple assessment score and educational intervention can improve the standard of neurological examination. This is the largest and – to our knowledge – only study to assess the standard of neurological examination internationally. This has implications for national neurological educators.

scholarly journals An unusual presentation of late oesophagojejunal anastomotic leak after total D2 gastrectomy

2012 ◽  
Vol 94 (2) ◽  
pp. e106-e108
Author(s):  
AR Verma ◽  
VM Patel ◽  
S Mikhail ◽  
E Zacharakis
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Anastomotic Leak ◽  
Epigastric Pain ◽  
Unusual Presentation ◽  
D2 Gastrectomy ◽  
Post Operative Period

Oesophagojejunal anastomotic leak usually presents in the early post-operative period with abdominal pain and sepsis. We report a case of late anastomotic leak presenting as epigastric pain with hyperamylasaemia and discuss the differential diagnosis.

scholarly journals Haemorrhagic Corpus Lutem Mimic Appendicitis

1970 ◽  
Vol 37 (2) ◽  
pp. 66-67
Author(s):  
Hasina Afroz ◽  
Rabeya Akhter ◽  
Shahela Jesmin
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Corpus Luteum ◽  
Ovarian Tumor ◽  
Rare Complication ◽  
Lower Abdominal Pain ◽  
Lower Abdomen ◽  
Key Word ◽  
Reproductive Life ◽  
Chocolate Cyst

Haemoperitoneum secondary to ruptured corpus luteum is a rare complication for women of reproductive life. The differential diagnosis of hemoperitoneum includes various types of acute abdomen that usually associated with acute lower abdominal pain and swelling lower abdomen. The differential diagnosis includes ruptured ectopic pregnancy, ruptured chocolate cyst, twisted ovarian tumor, pelvic inflammatory disease and pelvic peritonitis. Ruptured hemorrhagic corpus luteum is an uncommon cause of acute abdomem. Its occurrence is unknown but is likely quite frequent and without symptoms. Most cases are self limiting; enquire only observation with abdominal pain relieved with analgesics. Some need laparoscopy or laparotomy to achieve homeostasis if the patient is haemodynamically unstable. Key word: Haemoperitoneum, Appendicitis, Ruptured Corpus luteum.   DOI: 10.3329/bmj.v37i2.3596 Bangladesh Medical Journal 37(2) 2008 66-67

scholarly journals Pediatric Appendicitis Score in differential diagnosis of acute nonspecific abdominal pain in children: age matters

2021 ◽  
pp. 22-31
Author(s):  
V.G. Vakulchyk ◽  
◽  
A.V. Kapytski ◽  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Diagnostic Significance ◽  
Predictive Values ◽  
Detection Frequency ◽  
Specificity And Sensitivity ◽  
Appendicitis Score

Acute nonspecific abdominal pain in children is the most common problem requiring differential diagnosis with acute appendicitis. Scales for integrated assessment of individual symptoms and their combinations have been proposed and are constantly being developed that allow predicting the likelihood of acute appendicitis. Purpose to assess diagnostic value of Pediatric Appendicitis Score (PAS) in groups of children in different ages. Materials and methods. 374 children aged 4 to 15 years with acute abdominal pain were evaluated in prospective randomized blinded study. Statistical analysis: ROC – curves, specificity and sensitivity, positive and negative predictive values; Kullback criteria; logistic regression analysis; discriminant analysis. Results. Detection frequency and diagnostic significance of the PAS scale predictors as well as obtained results by using the Pediatric Appendicitis Score depend on children age significantly. In terms of diagnosis of acute appendicitis, the PAS scale shows the best results in older children. Conclusions. Results of Pediatric Appendicitis Score depend on children ages due to different diagnostic value of predictors used in the PAS scale. Pediatric surgeons should keep in your mind these data. Modification of the scale is required taking into account the patient’s age. Further analysis of the issue of PAS using is needed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: acute appendicitis, children, diagnosis, PAS scale.

Signs and Symptoms in Pediatrics

2015 ◽  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Back Pain ◽  
Sleep Disturbances ◽  
Signs And Symptoms ◽  
Diagnostic Procedures ◽  
Heart Murmurs ◽  
Physical Examinations ◽  
Ongoing Care

This convenient handbook is a comprehensive guide to the evaluation and treatment of more than 80 signs and symptoms. It is organized alphabetically, and each entry includes history and physical examinations; causes; differential diagnosis; diagnostic procedures; treatment approaches including when to refer and when to admit; ongoing care and follow-up; and prevention. Contents include: Abdominal pain Anxiety Back pain Chest pain Depression Diarrhea and steatorrhea Dizziness and vertigo Fatigue and weakness Fever Headache Heart murmurs Jaundice Rash Red eye/pink eye Sleep disturbances Speech and language concerns Vomiting Wheezing And more!

Abstract 120: Assessing the Impact of a Rural STEMI System of Care Initiative: Mission: Lifeline Wyoming

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
James R Langabeer ◽  
Daniel Gerard ◽  
Derek T Smith ◽  
Benjamin Leonard ◽  
Wendy Segrest ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Systems Of Care ◽  
Heart Association ◽  
Mortality Rates ◽  
Baseline Period ◽  
System Of Care ◽  
Primary Pci ◽  
Post Intervention ◽  
Ischemic Time ◽  
The Impact

Introduction: Regional systems of care for ST-elevation myocardial infarction (STEMI), such as in Minnesota and North Carolina, have demonstrated improvements in quality of care outcomes. The objective in this study was to collect baseline data on Wyoming statewide STEMI incidence and assess changes in ischemic times and mortality following deployment of a statewide, system of care initiative in the rural state of Wyoming. Methods: American Heart Association organized a STEMI initiative in 2012 in Wyoming to address the needs for enhanced rural cardiovascular care. Participating were all 10 STEMI-receiving centers in and around the state, 25 acute care/critical access hospitals, Wyoming Department of Health, 56 emergency medical service (EMS) agencies, and hundreds of volunteer multidisciplinary stakeholders. The initiative deployed approximately 30 training programs, placed 165 12-lead electrocardiogram (ECG) devices in ambulance service, and developed dozens of protocols concerning transfers, treatment, and transport for Wyoming and surrounding border-states. The study design was pre-posttest design, using observational methods of de-identified myocardial infarction data extracted from all 10 participating percutaneous coronary intervention (PCI) facilities’ National Cardiovascular Data Registry (NCDR) submissions. There were 2,301 total MI’s, and 889 STEMIs during calendar years 2013-2014 (24 months). We established the first two quarters as our baseline period, and compared differences in median values using Kruskal-Wallis (KW) and chi-square analyses of variances relative to the the subsequent 6 quarters across several outcome measures (total ischemic time, mortality, thrombolytic administration rates). Results: Wyoming has an extremely high transfer rates into PCI, over twice the national average (62%). These transfers produced a long total ischemic time of 291 minutes (nearly 5 hours) in the baseline period, with door-in-door-out times consuming nearly 120 minutes, median. There was a statistically significant 51 minute median reduction in total ischemic times following the program (291 in baseline quarters vs. 241 minutes in subsequent post-intervention periods; KW χ2=4.327, p<.05). There was simultaneously a significant increase in the percent of patients undergoing primary PCI (pPCI) from 54% to 57% (χ2=7.610, p<.01), coupled with a statistically significant reduction in the rate of thrombolytic administration s (46% in the baseline period vs. 37% in the subsequent periods; χ2=6.359, p<.05). Mortality rates were lower than national benchmarks, averaging 3.9% for all MI (5.3% for STEMI), but there were no statistical changes in mortality rates over time. Conclusions Mission: Lifeline Wyoming demonstrated statistically significant reductions in median total ischemic time and higher primary PCI reperfusion rates.

Sign in / Sign up

Export Citation Format

Share Document