Quality of care for acute abdominal pain in children

Yvonne Zurynski, Kate Churruca, Gaston Arnolda, Sarah Dalton, Hsuen P. Ting, Peter Damian Hibbert, Charlotte Molloy, Louise K. Wiles, Carl de Wet, Jeffrey Braithwaite*

*Corresponding author for this work

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Objective: To assess quality of care for children presenting with acute abdominal pain using validated indicators. Design: Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. Setting and participants: Medical records of children aged 1–15 years receiving care in 2012–2013 were sampled from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states; 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses. Outcome measures: Adherence to 21 care quality indicators and three bundles of indicators: bundle A-History; bundle B-Examination; bundle C-Imaging. Results: Five hundred and fourteen children had 696 visits for acute abdominal pain and adherence was assessed for 9785 individual indicators. The overall adherence was 69.9% (95% CI 64.8% to 74.6%). Adherence to individual indicators ranged from 21.6% for assessment of dehydration to 91.4% for appropriate ordering of imaging. Adherence was low for bundle A-History (29.4%) and bundle B-Examination (10.2%), and high for bundle C-Imaging (91.4%). Adherence to the 21 indicators overall was significantly lower in general practice (62.7%, 95% CI 57.0% to 68.1%) compared with ED (86.0%, 95% CI 83.4% to 88.4%; p<0.0001) and hospital inpatient settings (87.9%, 95% CI 83.1% to 91.8%; p<0.0001). Conclusions: There was considerable variation in care quality for indicator bundles and care settings. Future work should explore how validated care quality indicator assessments can be embedded into clinical workflows to support continuous care quality improvement.
Original languageEnglish
Pages (from-to)509-516
Number of pages8
JournalBMJ Quality and Safety
Issue number6
Early online date27 Nov 2019
Publication statusPublished - Jun 2020

Bibliographical note

Copyright the Author(s) 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • clinical practice guidelines
  • general practice
  • paediatrics
  • quality improvement


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