Clinical Predictors of Organic Aetiology in Children Presenting with Recurrent Abdominal Pain: A Retrospective Study

Janagam Usha Keerthi, N Shivaramakrishna Babji, M Alekya, Raman Kavya Sindhu
Author(s)
1Postgraduate, Department of Paediatrics, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. 2Professor and Head, Department of Paediatrics, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. 3Senior Resident,Department of Paediatrics, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.

Abstract

Background: Differentiating functional from organic aetiologies in paediatric recurrent abdominal pain (RAP) remains a significant clinical challenge. This study aimed to identify independent clinical features associated with organic RAP and to develop and validate a practical risk-stratification model. Material and Methods: A retrospective observational study evaluated 50 children (aged 4–18 years) presenting with RAP at a tertiary care center. Clinical characteristics and alarm symptoms were systematically analyzed. Variables approaching significance in univariate analysis were entered into a multivariable logistic regression model. A 7-item Paediatric Organic Abdominal Pain Prediction Score (POAPS) was developed based on alarm features, and its diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Among the 50 children (mean age 6.8 years; 56% female), organic etiologies were identified in 84% (n=42), whereas 16% (n=8) had functional disorders. An abnormal abdominal examination was the strongest independent predictor, demonstrating 100% predictive accuracy for organic disease. Other features included in the multivariable model were school absenteeism, localized pain site, fever, and urinary symptoms. The POAPS model showed excellent diagnostic discrimination with an area under the curve (AUC) of 0.857. At an optimal cut-off score of, the POAPS yielded 71.4% sensitivity, 100% specificity, and a 100% positive predictive value. Conclusion: Organic pathology is highly prevalent in this tertiary pediatric cohort. The POAPS serves as a highly specific, non-invasive bedside tool that accurately identifies high-risk patients, facilitating targeted investigations while safely minimizing unnecessary testing for children with functional RAP.

Keywords: Recurrent abdominal pain; Paediatric gastroenterology; POAPS (Paediatric Organic Abdominal Pain Prediction Score); Organic aetiology.

Outline