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To the Editor: The Rational Clinical Examination by Dr Ranji and colleagues¹ concluded that opiate administration in patients with acute abdominal pain may alter the physical examination findings, but these changes result in no significant increase in management errors. We hope these conclusions will help to modify the attitudes of pediatricians who are still reticent to use analgesic drugs in children presenting with acute abdominal pain.²

However, it is important to consider some of the limitations of the pediatric studies included in this systematic review. Each of those trials included a limited number of children and so were not adequately powered to detect significant differences between the group treated with opiates and the group treated with placebo for the main outcomes. For example, to have an 80% probability of identifying differences in missed diagnosis of appendicitis, one of the studies³ would have needed to enroll at least 1000 children per . . . [Full Text of this Article]

Daniele Radzik, MD
dradzik@tiscali.it
Department of Pediatrics
Hospital of Castelfranco
Castelfranco, Veneto
Italy

Jenny Bua, MD; Federico Marchetti, MD
Department of Pediatrics
Institute of Child Health, IRCCS
Burlo Garofolo, Trieste
Italy

RELATED LETTER

Opiates and Acute Abdominal Pain—Reply
Sumant R. Ranji, L. Elizabeth Goldman, David L. Simel, and Kaveh G. Shojania
JAMA. 2007;297(5):468.
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