Implementation of systematic screening for anxiety, disability and pain in children aged 8 to 18 years presenting with abdominal pain at a gastroenterology division of a large medical center resulted in an increase in screening rates and psychological referrals in a study published in Pediatrics.
A large gastroenterology division in an urban medical center implemented a screening program in 5221 children aged 8 to 18 years with and without abdominal pain. As part of this screening, functional disability was assessed with the Functional Disability Inventory, patient-reported anxiety was evaluated with the Screen for Child Anxiety and Related Disorders-Child, and pain levels were assessed using a 0 to 10 numeric rating scale.
The study’s primary outcome measure was the percentage of patients who were screened successfully. Total scores from each screening measure, referral rates to psychiatrists or other psychological services, and screening-related feedback from providers were secondary outcomes.
Study participants who were found to have anxiety, based on their Screen for Child Anxiety and Related Disorders score, had higher Functional Disability Inventory scores (16.29 vs 11.54, respectively; P <.001) and higher pain levels (4.63 vs 3.72, respectively; P <.001) compared with patients without anxiety symptoms. After implementation of the screening program, the referral rate for psychological referrals increased from 8.3 to 15.2 per 1000 patients per month. In addition, the majority of providers rated the screening program positively, noting that “screening revealed important information that would not have otherwise been known during the visit, helped frame the conversation with the patient, and offered a systematic approach to care.”
The inclusion of only children limits the generalizability of the screening program’s feasibility in adult patients.
“Continued efforts toward systematically integrating psychological screening methods to enhance medical care will advance the field and improve the quality of care of patients [with functional abdominal pain disorders],” concluded the study authors.
Cunningham NR, Moorman E, Brown CM, et al. Integrating psychological screening into medical care for youth with abdominal pain. Pediatrics. 2018;142(2):e20172876.