Medical Record Review
Some Patient, Same Problem, Two Different Stories: The Value of a Prospective Diary in Assessing Chronic Abdominal Pain
Editors: Lawrence F. Nazarian, MD.
Evaluation of the child with chronic or recurrent abdominal pain can give the pediatrician a stomach ache, especially since the majority of these children do not have clear-cut causes for their pain and because the sorting out of organic and emotional factors is difficult. At the very least, the clinician deserves to have complete and accurate information on which to base an evaluation. Essential elements of such an evaluation are presented in the Guide for Record Review distributed with this issue. Unfortunately, the history given by patient and parents often is vague and incomplete, since this is a condition that has been going on for a while and may have variable manifestations.
If a prospective diary is kept for 2 or 3 weeks, the specific details of the child's condition will be recorded as they occur, and a variety of relevant factors, such as diet and activity, can be noted at the same time, so that correlations can be detected. The focus on accurate data collection also will induce the child and parents to recall with more clarity those events that have occurred before. Information from outside sources, such as relatives and school personnel, is more likely to be accurate if the family is oriented toward good history taking.
