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Using patient characteristics to predict usefulness of abdominal computed tomography in children
Eric Biondi1, Sabrina Macduff, Peter Capucilli
1Department of Pediatrics, School of Medicine, University of Rochester, Rochester, New York 14642, USA. eric_biondi@urmc.rochester.edu
Insights
Most pediatric abdominal computed tomography (CT) scans are unnecessary. Clinical factors like leukocytosis and peritoneal signs can indicate a necessary CT scan, but predictive power is limited.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Clinical Decision Making
Background:
- Abdominal computed tomography (CT) scans are frequently used in pediatric care.
- The clinical utility and necessity of these scans are often debated.
- Predictive factors for the usefulness of abdominal CT in children require further investigation.
Purpose of the Study:
- To identify clinical symptoms, physical findings, and laboratory values that predict the usefulness of abdominal CT scans in children.
- To differentiate between necessary, unnecessary but helpful, and unhelpful CT scans.
Main Methods:
- Retrospective review of pediatric abdominal CT scans from June 2009 to November 2011.
- Independent categorization of CT scans by pediatric hospitalists into necessary, unnecessary but helpful, or neither.
- Logistic regression analysis to assess the predictive power of 21 clinical variables.
Main Results:
- Out of 399 CT scans, 18% were necessary, 26% unnecessary but helpful, and 57% neither.
- Leukocytosis, peritoneal signs, and male gender were strongly correlated with necessary CT scans.
- History of abdominal surgery, tachypnea, and leukocytosis were correlated with unnecessary but helpful CT scans.
Conclusions:
- The majority of abdominal CT scans in children were found to be unnecessary and unhelpful.
- While certain clinical variables show correlation with scan necessity or helpfulness, their overall predictive power is relatively low.
- Clinical variables may assist, but careful consideration is needed when deciding on abdominal CT orders for pediatric patients.
Objective:
The study goal was to determine whether clinical symptoms, physical findings, or laboratory values predict the usefulness of abdominal computed tomography (CT) scans in children.
Methods:
We conducted a retrospective review of pediatric patients who received an abdominal CT scan between June 2009 and November 2011 at an urban medical center. A panel of pediatric hospitalists independently categorized each CT read as: (1) necessary for diagnosis; (2) unnecessary but helpful for diagnosis; or (3) neither necessary nor helpful for diagnosis. Two multiple logistic regression models examined 21 clinical variables to assess their ability to differentiate between: (1) necessary and unnecessary CT scans; and (2) helpful and unhelpful CT scans.
Results:
A total of 399 CT scans were analyzed. Seventy (18%) of these were categorized as necessary, 103 (26%) as unnecessary but helpful, and 226 (57%) as neither necessary nor helpful. Three variables were strongly correlated with necessary CT scans: leukocytosis, peritoneal signs, and male gender. The probability of a CT scan being necessary was 57% in patients with all 3 findings and 8% in those with none. Three variables were also strongly correlated with unnecessary but helpful CT scans: history of abdominal surgery, tachypnea, and leukocytosis. The probability of a CT scan being helpful was 84% in patients with all 3 findings and 35% in those with none of the 3 findings.
Conclusions:
The majority of abdominal CT scans were unnecessary and unhelpful. Knowing which clinical variables correlate strongly with necessary or helpful abdominal CT scans may assist clinicians in deciding whether to order this test; however, the predictive power of these variables remains relatively low.
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