• Itaru Hayakawa, Hiroshi Sakakibara, Yukari Atsumi, Hiroshi Hataya, and Toshiro Terakawa.
• Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: itaruhayakawa@gmail.com.
• Am J Emerg Med. 2017 Jun 1; 35 (6): 819-822.

BackgroundAbdominal pain is common in children, but expeditious diagnosis of life- or organ-threatening diseases can be challenging. An evidence-based definition of tachycardia in children was established recently, but its diagnostic utility has not yet been studied.ObjectiveTo test the hypothesis that abdominal pain with tachycardia may pose a higher likelihood of life- or organ-threatening diseases in children.MethodsA nested case-control study was conducted in a pediatric emergency department in 2013. Tachycardia was defined as a resting heart rate of more than 3 standard deviations above the average for that age. Life- or organ-threatening diseases were defined as "disorders that might result in permanent morbidity or mortality without appropriate intervention." A triage team recorded vital signs before emergency physicians attended patients. Patients with tachycardia (cases) and without tachycardia (controls) were systematically matched for age, sex, and month of visit. The groups were compared for the presence of life- or organ-threatening diseases.ResultsThere were 1683 visits for abdominal pain, 1512 of which had vital signs measured at rest. Eighty-three patients experienced tachycardia, while 1429 did not. Fifty-eight cases and 58 controls were matched. Life- or organ-threatening diseases were more common in the case group (19%) than the control group (5%, p=0.043). The relative risk of tachycardia to the presence of the diseases was 3.7 (95% confidence interval 1.2-12.0).ConclusionTachycardia significantly increased the likelihood of life- or organ-threatening diseases. Tachycardia in children with abdominal pain should alert emergency physicians to the possibility of serious illness.Copyright © 2017 Elsevier Inc. All rights reserved.

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