The use of abdominal imaging studies in children visiting emergency department was variable and unsystematic

Abstract

Aim: As imaging is used for various reasons in children with acute gastrointestinal complaints, we evaluated the indications and diagnostic yield of abdominal imaging, particularly ultrasound at emergency department (ED). Methods: Indications and imaging reports of consecutive children who had undergone abdominal imaging in general, surgical and paediatric EDs in the Tampere University Hospital, Finland, in 2015 were collected. Symptoms, clinical findings, imaging indications and findings were categorised and further analysed.Results: Altogether 394 imaging studies, 310 ultrasounds, 72 X-rays and 12 computed tomographies (CT), for 348 children (55% boys) aged 0-16.9 years, median 7.1 years, were performed. The most common indications for ultrasound were suspected appendicitis or infection (36%) and explanation for symptoms (32%), for X-ray suspected foreign body (39%) and obstruction (39%) and for CT trauma (50%). The cause of the symptoms or a clinically significant finding was established in 23% of ultrasounds, varying from 0% to 50% depending on the indication, symptoms and age.Conclusion: There was wide variation in the indications and yield of abdominal imaging.The clinical benefits, particularly those of US, were often questionable, even leading to delayed diagnosis and complications. More uniform imaging guidelines are needed in the paediatric ED.

Exploring the Diagnostic Spectrum of Children with Raised Faecal Calprotectin Levels

“…Sub-group analysis within the 500+ group µg/g showed that for children where the index FC was related to a new diagnosis of IBD, they were more likely to have abnormal abdominal USSs than if they had an infectious GI condition or subsequent IBD. While abnormalities may be seen in USSs in children with infectious diarrhoea [26][27][28], abdominal USSs carried out on children presenting with diarrhoea, bleeding diarrhoea, or weight loss have positive findings in approximately 20% of cases [29]. In one further study, abnormal USS findings did not distinguish between functional and organic conditions [16].…”

The Diagnostic Accuracy of Abdominal X-ray in Childhood Constipation: A Systematic Review of the Literature

“…Clinical practice guidelines discourage the use of AXR for the diagnostic workup of children with constipation due to its limited value, misleading nature, and radiation exposure [7][8][9][10][11][12][13][14]. AXR is an imperfect test for the assessment of constipation in children due to the absence of comparative radiologic normative data from children without constipation and the fact that symptoms may not correlate with the extent of faecal loading seen on the AXR or if other factors, such as air in the colon rather than the stool, may play a role in symptomatology.…”

“…While available data discourage the use of AXR for the evaluation of functional constipation in children due to its limited value, radiation exposure, as well as its possible misleading nature [7][8][9][10][11][12][13][14], a significant number of AXRs continue to be performed on children with constipation, particularly in the emergency department [15][16][17][18]. This has led to quality improvement projects that aim to reduce the number of abdominal X-rays performed in such children, with them showing promising results [19][20][21].…”