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ACR Appropriateness Criteria® Abdominal Pain-Child

, HaiThuy N Nguyen1, Sherwin S Chan2

  • 1Children's Hospital Los Angeles and Keck School of Medicine USC, Los Angeles, California.

Journal of the American College of Radiology : JACR
|February 17, 2026
PubMed

Insights

Pediatric abdominal pain diagnosis often requires imaging due to a broad differential and children's limited communication. This review discusses appropriate imaging for various acute abdominal pain scenarios in children, guided by evidence-based criteria.

Area of Science:

  • Pediatric Radiology
  • Gastroenterology
  • Clinical Decision Support

Background:

  • Abdominal pain in children presents a broad differential diagnosis that can vary significantly with age.
  • Children's difficulty in articulating pain necessitates the use of diagnostic imaging for accurate assessment.
  • Acute abdominal pain in pediatric patients requires a systematic approach to diagnosis.

Purpose of the Study:

  • To review appropriate diagnostic imaging strategies for children presenting with acute abdominal pain.
  • To discuss imaging modalities for specific conditions including constipation, intussusception, small bowel obstruction, surgical complications, and necrotizing enterocolitis.
  • To highlight the role of evidence-based guidelines in pediatric abdominal pain management.

Main Methods:

  • The study discusses various clinical scenarios of acute abdominal pain in children.
  • It outlines initial imaging studies deemed appropriate or potentially appropriate based on evidence and expert consensus.
  • The American College of Radiology Appropriateness Criteria methodology, including GRADE and RAND/UCLA methods, is referenced for guideline development.

Main Results:

  • The review details appropriate imaging for common pediatric abdominal pain causes like constipation and intussusception.
  • It addresses imaging considerations for complex cases such as small bowel obstruction and necrotizing enterocolitis.
  • The American College of Radiology Appropriateness Criteria serve as a foundation for evidence-based recommendations.

Conclusions:

  • Diagnostic imaging is crucial for evaluating acute abdominal pain in children due to diagnostic complexity.
  • Evidence-based guidelines, like the American College of Radiology Appropriateness Criteria, aid in selecting appropriate imaging studies.
  • Expert consensus plays a vital role when peer-reviewed literature is limited for specific pediatric abdominal pain presentations.

Keywords:
AUCAbdomenAppropriate Use CriteriaAppropriateness CriteriaNECbowel obstructionintussusceptionpediatricpostsurgical

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