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In Reply: We agree with Dr Radzik and colleagues that the limited number of pediatric studies warrants some caution in applying our study's results. As they note, a large randomized trial would be necessary to detect a statistically significant increase in management errors, but this is largely a function of the low baseline rates of such errors. In the trial cited by Radzik et al,¹ the sample size required to detect a difference of 1 delayed diagnosis of appendicitis was calculated based on a baseline rate of only 1%. The investigators in that trial found 1 management error out of 108 patients; thus, their sample-size calculation assumes a target of zero management errors.

Our analysis found the pooled absolute difference in potential management errors was 0.8% in favor of opiates (ie, fewer management errors) in the 3 pediatric studies, with a 95% confidence interval extending from 8.6% in favor of . . . [Full Text of this Article]

Sumant R. Ranji, MD
sumantr@medicine.ucsf.edu

L. Elizabeth Goldman, MD
Department of Medicine
University of California, San Francisco

David L. Simel, MD, MHS
Durham Veterans Affairs Medical Center
Durham, NC

Kaveh G. Shojania, MD
University of Ottawa
Ottawa, Ontario

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Opiates and Acute Abdominal Pain
Daniele Radzik, Jenny Bua, and Federico Marchetti
JAMA. 2007;297(5):467-468.
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