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Plain abdominal radiography in the detection of major disease in children: a prospective analysis
S G Rothrock1, S M Green, C B Hummel
1Department of Emergency Medicine, Orlando Regional Medical Center, Florida.
Insights
This study found that using five specific clinical criteria can effectively identify children needing abdominal X-rays, reducing unnecessary imaging and saving costs. These criteria help detect major abdominal diseases in pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Clinical Decision Making
Background:
- Plain abdominal radiographs are frequently used in pediatric emergency evaluations.
- Identifying high-yield clinical criteria can optimize the use of diagnostic imaging.
Purpose of the Study:
- To prospectively evaluate previously described high-yield clinical criteria for ordering plain abdominal radiographs in children.
- To assess the effectiveness of these criteria in detecting major abdominal diseases.
Main Methods:
- Prospective, observational study involving 354 children (≤15 years) in emergency departments.
- Physicians completed data forms on clinical features before radiograph review.
- Data analyzed for sensitivity, specificity, and predictive values of high-yield criteria.
Main Results:
- 17% of children had major abdominal diseases requiring intervention.
- Five clinical features (prior surgery, foreign body ingestion, abnormal bowel sounds, distention, peritoneal signs) showed 93% sensitivity and 40% specificity for major disease.
- Using these criteria could omit 38% of radiographs, saving an estimated $20,000.
Conclusions:
- Restricting abdominal radiographs to children with at least one of the five high-yield clinical features can identify most diagnostic radiographs for major abdominal diseases.
- This approach optimizes imaging resource utilization in pediatric emergency care.
Study Objective:
To prospectively evaluate previously described high-yield clinical criteria for obtaining plain abdominal radiographs in the emergency evaluation of children.
Design:
Prospective, observational study.
Setting:
Emergency departments of a university medical center and an affiliated county hospital.
Participants:
Three hundred fifty-four children 15 years old or younger who underwent plain abdominal radiography during a one-year period.
Methods And Measurements:
Physicians ordering plain abdominal radiographs completed data forms that included historical and physical examination information before viewing films. At a later date, records of all patients were reviewed for radiologist interpretation and final diagnosis. The data were analyzed to determine the sensitivity, specificity, and predictive values of previously described high-yield criteria (from a retrospective series) in detecting radiographs that were diagnostic or suggestive of "major" abdominal disease.
Main Results:
Sixty-one patients (17%) had major diseases potentially requiring procedural intervention (eg, appendicitis, ingested foreign bodies, and intussusception), whereas 296 patients (83%) had minor diseases not requiring procedural intervention (eg, gastroenteritis and nonabdominal diagnoses). The presence of any of the following features--prior abdominal surgery, foreign body ingestion, abnormal bowel sounds, abdominal distention, or peritoneal signs--was 93% sensitive and 40% specific in detecting diagnostic or suggestive radiographs in patients with major disease. Positive and negative predictive values were 11% and 99%, respectively. If only these criteria had been used to obtain radiographs, 38% of films would have been omitted (at an estimated savings of $20,000) with only two suggestive radiographs missed.
Conclusion:
Our results suggest that restricting abdominal radiographs to patients with at least one of these five high-yield clinical features will detect most diagnostic and suggestive radiographs in children with major abdominal diseases.