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Quality of care for acute abdominal pain in children
  1. Yvonne Zurynski1,2,
  2. Kate Churruca1,
  3. Gaston Arnolda1,
  4. Sarah Dalton3,
  5. Hsuen P Ting1,
  6. Peter Damian Hibbert1,4,
  7. Charlotte Molloy1,4,
  8. Louise K Wiles1,4,
  9. Carl de Wet5,
  10. Jeffrey Braithwaite1
  1. 1 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
  2. 2 NHMRC Partnership Centre in Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia
  3. 3 Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
  4. 4 Division of Health Sciences, Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), Adelaide, South Australia, Australia
  5. 5 Healthcare Improvement Unit, Queensland Government Clinical Excellence Division, Brisbane, Queensland, Australia
  1. Correspondence to Professor Jeffrey Braithwaite, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia; jeffrey.braithwaite{at}


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.

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

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  • Contributors All authors read and contributed critical comments and suggestions that were incorporated into the manuscript. YZ interpreted the results, ensured additional analyses were undertaken and led the writing of the manuscript. KC and GA contributed substantial intellectual input into the interpretation of results and writing of the manuscript. PDH was the programme manager for the CTK study, oversaw data collection and analysis and significantly contributed to the interpretation of data, through his deep knowledge of the CTK study methodology. CM and LKW helped design the data collection instruments, collected data, carried out the initial analyses and interpreted the results. HPT and GA led the statistical analyses and contributed to the interpretation of data. JB was the chief investigator on the CTK study—he conceived the study and its design contributing intellectual guidance at all stages, and approved the final manuscript. LKW and CdW contributed to the draft and final manuscripts. All authors had full access to data and statistical analysis.

  • Funding This study was funded by the National Health and Medical Research Council (grant number: APP1065898) (

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Royal Australian College of General Practitioners (HREC/14/SCHN/113; HREC/14/QRCH/91; HREC/14/WCHN/68; NREEC 14-008).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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