Clinical profiles and outcomes of paediatric patients presenting with abdominal pain to the emergency medicine department of Muhimbili National Hospital, Dar es salaam, Tanzania

Abstract

Background: Abdominal pain in children can represent benign aetiologies and true life threatening emergencies. Aetiologies of paediatric abdominal pain vary geographically, and have not been studied in acute care settings in Tanzania. Aim: To describe the clinical profiles and outcomes of paediatric patients presenting with abdominal pain to the EMD-MNH. Methodology: This was a prospective cohort study of children aged 1mo-18yrs presenting with abdominal pain at the EMD-MNH. A case report form (CRF) was used to collect data on a convenience consecutive sample of patients from June to December 2016. The CRF included demographics, clinical presentation, management, diagnoses, disposition, and 24-hour, seven-day and three-month mortality. Data was summarised using descriptive statistics and analysed using counts, percentages, median; inter quartile range, relative risk, Mann-Whitney U test and logistic regression model was applied. Results: Total of 1855 children were screened, of which 184 (9.9%) children meeting the inclusion criteria were enrolled. The median age was 3.5yrs (IQR 1.3-7.0 yrs). 124 (67.4%) were male. 138 (75.0%) were referred from peripheral hospitals. Top EMD diagnoses were hernia, intra-abdominal malignancy and sickle cell disease. Most common interventions provided at the EMD were intravenous fluids 57 (30.9%), antibiotics 55 (29.9%) and analgesia 43 (23.4%). From the EMD, 37 (20.1%) were discharged home, 83 (45.1%) were admitted to medical wards and 48 (26.1%) to the surgical wards. Overall, 16 (8.7%) of these children underwent an operation. 24-hour, 7-day and 3-month mortality were 1.1%, 6.5% and 14.4%, respectively. Overall in hospital mortality was 9.8%. Conclusion & Recommendations: Abdominal pain is a common complaint amongst paediatric patients presenting to the EMD-MNH. This presentation was associated with significant morbidity and mortality as evidence by very high admission rate, need for surgical intervention and an overall mortality rate of nearly 10%. Further studies and quality improvement efforts should focus in identifying aetiologies, risk stratification, and appropriate interventions optimize outcomes.