Lesson from a Single Pediatric Emergency Department: Potentially Applicable Radiation-Minimizing Practices for...

In emergency departments (EDs), choosing imaging modalities for adolescents with abdominal pain requires balancing diagnostic accuracy and minimizing radiation exposure. This retrospective study compared imaging modalities in adolescents (16-18 years) presenting with non-traumatic acute abdominal pain between the pediatric ED (PED) and adult ED (AED) in the same institution.

We conducted a retrospective study in patients aged 16-18 years who presented to AED or PED in the same tertiary university-affiliated hospital due to non-traumatic acute abdominal pain between January 2019 and July 2023 (study period = 55 months). The patient freely decided on the emergency department (ED) to be admitted.

This study analyzed 950 patients (683 in AED and 267 in PED). Actionable and surgical emergencies were comparable between both EDs (p = 0.617 and 0.245, respectively). PED physicians used fewer CT scans (28.5% vs. 37.9%, p = 0.006) and fewer CT phases (mean, 0.49 vs. 0.76, p < 0.001). Despite more patients undergoing X-rays in PED (77.9% vs. 61.6%, p < 0.001), the number of X-ray images was lower than in AED (mean, 0.9 vs. 1.1, p < 0.001). PED performed more point-of-care US (POCUS) than AED (28.0% vs. 0.1%, p < 0.001). Both EDs had comparable safety outcomes (revisits and missed surgical emergencies).

PED physicians utilize POCUS more frequently and employ fewer CT scans, X-ray images, and CT phases than AED physicians in adolescents presenting with non-traumatic acute abdominal pain. Despite lower radiation exposure, the PED achieved safety outcomes comparable to the AED's, indicating that a PED-style imaging strategy may be safely applied to adolescent abdominal pain evaluation.