Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain
10.5223/pghn.2019.22.3.225
- Author:
Michael W VAN KALLEVEEN
1
;
Elise J NOORDHUIS
;
Carole LASHAM
;
Frans B PLÖTZ
Author Information
1. Department of Pediatrics, Tergooi Hospital, Blaricum, the Netherlands. fbplotz@tergooi.nl
- Publication Type:Original Article
- Keywords:
Guideline adherence;
Interobserver variability;
Intra-observer variability;
Pediatricians;
Abdominal pain
- MeSH:
Abdominal Pain;
Child;
Cohort Studies;
Guideline Adherence;
Hospitals, Teaching;
Humans;
Observer Variation;
Prospective Studies;
Retrospective Studies
- From:Pediatric Gastroenterology, Hepatology & Nutrition
2019;22(3):225-232
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. METHODS: The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and inter-observer variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. RESULTS: A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35–0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower inter-observer variability than in the retrospective study. Adherence to the guideline was 66.8%. CONCLUSION: We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.
