Abstract
Diagnostic imaging is often an integral component in the workup of a pediatric patient with acute abdominal pain. The purpose of this study was to compare the diagnostic value of a three-view acute abdominal series (AAS) with that of a single supine view (SSV) in children with acute abdominal pain. All subjects aged ≤18 years that underwent an emergency three-view AAS examination for acute abdominal pain at a single urban hospital system were included. Retrospective evaluation of radiological diagnosis, number of radiological images, further imaging, management, and clinical outcomes was performed. “Positive” AAS studies were compared with corresponding SSV images for direct comparison of diagnostic value. Standard nonparametric statistical evaluation was performed. Five hundred forty-one AAS studies were included in the study. Greater than three radiographs were acquired in 29 % (153/541) of the subjects. Two hundred ninety-nine out of 541 AAS studies included a technically adequate SSV of the abdomen and pelvis. Most AAS examinations were categorized as negative (n = 485; 90 %). Of the 56 examinations initially classified as positive, there was no significant statistical difference between diagnostic accuracy between the AAS and SSV on retrospective evaluation. For pediatric subjects with nontraumatic acute abdominal pain, the yield of conventional radiographic study is exceedingly low. If required, a technically adequate single supine anteroposterior (AP) view of the abdomen and pelvis is sufficient for initial radiographic evaluation while reducing unnecessary radiation exposure to the patient.
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References
National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables (2011) Centers for disease control and prevention. http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2011_ed_web_tables.pdf. Accessed 15 Dec 2015
Stoker J, van Randen A, Lameris W, Boermeester MA (2009) Imaging patients with acute abdominal pain. Radiology 253(1):31–46. doi:10.1148/radiol.2531090302
Linet MS, Kim KP, Rajaraman P (2009) Children’s exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol 39(Suppl 1):S4–26. doi:10.1007/s00247-008-1026-3
Ambulatory health care data (2015) Centers for disease control and prevention. Updated 23 Sept 2015. http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm. Accessed 15 Dec 2015
Dorfman AL, Fazel R, Einstein AJ, Applegate KE, Krumholz HM, Wang Y, Christodoulou E, Chen J, Sanchez R, Nallamothu BK (2011) Use of medical imaging procedures with ionizing radiation in children: a population-based study. Arch Pediatr Adolesc Med 165(5):458–464. doi:10.1001/archpediatrics.2010.270
MacKersie AB, Lane MJ, Gerhardt RT, Claypool HA, Keenan S, Katz DS, Tucker JE (2005) Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology 237(1):114–122. doi:10.1148/radiol.2371040066
Zellow KS, MacInnes M, Kurzencwyg D, Rawal S, Jaffer R, Kovacina B, Stein LA (2008) The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology 248(3):887–893. doi:10.1148/radiol.2483071772
Mazzei MA, Guerrini S, Cioffi Squitieri N, Cagini L, Macarini L, Coppolino F, Giganti M, Volterrani L (2013) The role of US examination in the management of acute abdomen. Crit Ultrasound J 5(Suppl 1):S6. doi:10.1186/2036-7902-5-S1-S6
Dhillon S, Halligan S, Goh V, Matravers P, Chambers A, Remedios D (2002) The therapeutic impact of abdominal ultrasound in patients with acute abdominal symptoms. Clin Radiol 57(4):238–271. doi:10.1053/crad.2001.0862
Gaitini D (2011) Imaging acute appendicitis: state of the art. J Clin Imaging Sci 1:49. doi:10.4103/2156-7514.85778
Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, et al. (2011) ACR appropriateness criteria right lower quadrant pain—suspected appendicitis. J Am Coll Radiol 8(11):749–755. doi:10.1016/j.jacr.2011.07.010
Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, Babyn PS, Dick PT (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241(1):83–94. doi:10.1148/radiol.2411050913
Partrick DA, Janik JE, Janik JS, Bensard DD, Karrer FM (2003) Increased CT scan utilization does not improve the diagnostic accuracy of appendicitis in children. J Pediatr Surg 38(5):659–662. doi:10.1016/jpsu.2003.5017
Hryhorczuk AL, Mannix RC, Taylor GA (2012) Pediatric abdominal pain: use of imaging in the emergency department in the United States from 1999 to 2007. Radiology 263(3):778–785. doi:10.1148/radiol.12111726
Singh A, Danrad R, Hahn PF, Blake MA, Mueller PR, Novelline RA (2007) MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics 27(5):1419–1431. doi:10.1148/rg.275065021
Laméris W et al. (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 338:b2431
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He, L., Park, E., Vachhani, N. et al. Acute abdominal pain in children: usefulness of three-view abdominal radiographs in the emergency department. Emerg Radiol 23, 469–475 (2016). https://doi.org/10.1007/s10140-016-1423-0
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DOI: https://doi.org/10.1007/s10140-016-1423-0