ACR Appropriateness Criteria® Vomiting in Infants

Alazraki, Adina; Rigsby, Cynthia K.; Iyer, Ramesh S.; Bardo, Dianna M. E.; Brown, Brandon P.; Chan, Sherwin S; Chandra, Tushar; Dietrich, Ann; Falcone, Richard A.; Garber, Matthew; Gill, Anne E.; Levin, Terry L.; Moore, Michael J.; Nguyen, Jie C.; Shet, Narendra; Squires, Judy; Trout, Andrew T.; Karmazyn, Boaz

doi:10.1016/j.jacr.2020.09.002

Cited by 8 publications

(4 citation statements)

References 47 publications

(76 reference statements)

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“…These data were not found in our studied patients. The causes of acute vomiting in the newborn can be gastrointestinal or non-gastrointestinal 12 . Of the gastrointestinal causes, there are those of obstructive and non-obstructive origin.…”

Section: Discussionmentioning

confidence: 99%

“…An abdominal radiography should be performed on any child with suspected intestinal obstruction 16 . The upright or transverse lateral view may reveal distended bowel loops and/or air-fluid levels consistent with intestinal obstruction (in a child with bilious vomiting, abdominal pain, and distension), as well as a dilated stomach in pyloric stenosis, and free air under the diaphragm in the case of a perforation of the hollow viscus 12,16 . The abdominal radiographs of both groups in our study were normal.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute non-biliary vomiting without abdominal distention associated with elevated serum lactate in term neonates

Rodríguez-Balderrama¹,

Alanís-García²,

Nieto-Sanjuanero³

et al. 2023

RMU

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Objective. This retrospective study aimed to analyze the clinical evolution of newborns who presented acute vomiting without abdominal distension and who presented lactacidemia in the rooming-in area or transitional nursery in a tertiary care hospital. Material and methods. An observational, comparative, retrospective, and cross-sectional study was performed from January 1, 2021, to December 22, 2021. Records of newborns with acute vomiting were reviewed, and two groups, Group A with elevated lactate and Group B with normal lactate, were formed. Results. The sample consisted of 62 neonates, of which 41 (66%) had elevated serum lactate (Group A). Logistic regression was performed, finding that time to resolution in hours had a statistical significance of 0.003 and an odds ratio of 1.278 in Group A (18 ± 10) to restart the oral route (p < 0.05). In contrast, Group B had a higher platelet count (p < 0.001). Conclusions. We found elevated serum lactate in 66% of the neonates studied with acute vomiting without abdominal distension in the rooming-in area or transitional nursery, a finding not reported to date in the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute non-biliary vomiting without abdominal distention associated with elevated serum lactate in term neonates

Rodríguez-Balderrama¹,

Alanís-García²,

Nieto-Sanjuanero³

et al. 2023

RMU

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“…46 The ACR Appropriateness Criteria for evaluation of vomiting infants indicates that ultrasound of the abdomen is the imaging modality of choice for this consideration. 48 Finally, malrotation or midgut volvulus represents another surgical emergency in early childhood, presenting anytime from birth to age 5 when the incidence begins to decrease. 46 While ultrasound might be effective in demonstrating findings suggestive of this diagnosis, the primary imaging modality of choice is a fluoroscopic upper gastrointestinal (GI) series.…”

Section: Considerations For Special Populationsmentioning

confidence: 99%

Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis

Wolfe¹,

Halsey-Nichols²,

Ritter³

et al. 2022

OAEM

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Abdominal pain is a common presenting complaint in the emergency department, and utilization of diagnostic imaging is often a key tool in determining its etiology. Plain radiography has limited utility in this population. Computed tomography (CT) is the imaging modality of choice for undifferentiated abdominal pain. Ultrasound and magnetic resonance imaging may be helpful in specific scenarios, primarily in pediatrics and pregnancy, and offer the benefit of eliminating ionizing radiation risk of CT. Guidance for imaging selection is determined by location of pain, special patient considerations, and specific suspected etiologies. Expert guidance is offered by the American College of Radiology Appropriateness Criteria ® which outlines imaging options based on location of pain.

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“…Non-bilious vomiting is commonly innocuous and occurs as a result of gastro-esophageal reflux while bile-stained vomiting is typically caused by partial or complete bowel obstruction distal to the ampulla of Vater. 1 Bilious vomiting in the paediatric age-group requires urgent evaluation. It may herald lifethreatening midgut malrotation with volvulus (MMWV) of the intestine about the superior mesenteric artery (SMA) and associated bowel ischaemia or necrosis.…”

Section: Introductionmentioning

confidence: 99%

A digital audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting

Messiahs

Pitcher

2022

South African Journal of Radiology

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Background: Bilious vomiting in children requires an urgent evaluation with upper gastrointestinal (UGI) fluoroscopy as it may herald life-threatening midgut malrotation with volvulus (MMWV). There are no published data available on the duration of time-critical UGI workflow steps.Objectives: A digital audit of workflow in emergency UGI contrast studies performed on children with bile-stained vomiting at a large South African teaching hospital.Method: A retrospective study was conducted from 01 May 2012 – 31 May 2019. A customised search of the institutional radiology information system (RIS) defined all children with bilious vomiting who underwent emergency UGI fluoroscopy. Extracted RIS timestamps were used to calculate the median duration of the ‘approval’, ‘waiting’, ‘study’ and ‘reporting’ times. One-way analysis of variance and Chi-squared tests assessed the association between key parameters and the duration of workflow steps, with 5% significance (p 0.05).Results: Thirty-seven patients (n = 37) with median age 0.8 months were included, of whom 20 (54%) had an abnormal C-loop. The median ‘total time’ from physician request to report distribution was 107 min (interquartile range [IQR]: 67−173). The median ‘approval’ (6 min; IQR: 1–15) and ‘reporting’ (38 min; IQR: 17–91) times were the shortest and longest workflow steps, respectively. Abnormal C-loops (p = 0.04) and consultant referrals (p = 0.03) were associated with shorter ‘approval’ times. The neonatal ‘waiting’ time was significantly longer than that for older patients (p = 0.02).Conclusion: The modern RIS is an excellent tool for time-critical workflow analyses, which can inform interventions for improved service delivery.

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ACR Appropriateness Criteria® Vomiting in Infants

Cited by 8 publications

References 47 publications

Acute non-biliary vomiting without abdominal distention associated with elevated serum lactate in term neonates

Acute non-biliary vomiting without abdominal distention associated with elevated serum lactate in term neonates

Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis

A digital audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting

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