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Three Part Question

In [young children with abdominal pain] does [severity of pain on pain scale] correlate [with the severity of pathology]

Clinical Scenario

A 4 year old boy comes to the Emergency Department complaining that his tummy hurts. He tells you it's really painful. You wonder, does this child's severity of pain mean he is more likely to have more serious underlying pathology?

Search Strategy

Medline 1950 to june week 1 2007 using the OVID interface and EMBASE 1980 - week 22 2007
[{exp Abdominal Pain/ OR exp Abdomen, Acute/ OR abdo$ pain.mp} AND {exp Pain Measurement/ OR pain score.mp OR pain scale.mp} AND exp Diagnosis/ Or Diagnosis, Differential) AND{exp "Severity of Illness Index"/}] LIMIT to human AND English And All Child

Search Outcome

MEDLINE: 33 papers were found and EMBASE: 2 papers were found of which none were relevent.

Comment(s)

We are all in the habit of pain scoring children and it is often a natural assumption in everyday clinical practice that more severe pain may indicate more severe underlying pathology. However pain perception varies widely between individuals. More research needs to be done into the relationship between pain and serious abdominal pathology in children. The main search results were papers concerning pain management, chronic pain and specific pain scales. The use of severity of pain as a diagnostic tool has not been investigated specifically in children.

Clinical Bottom Line

There is no evidence base to link children's perceived severity of pain to the likelihood of serious intra-abdominal pathology.